Thalassemia Major Is a Major Risk Factor for Pediatric Melioidosis in Kota Kinabalu, Sabah, Malaysia

SM Fong, Ke Wong, Masako Fukushima, Tsin Yeo

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.

    Methods: This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012.

    Results: Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41%) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59%) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012.

    Conclusions: 
    Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death. 
    Original languageEnglish
    Pages (from-to)1802-1807
    Number of pages6
    JournalClinical Infectious Diseases
    Volume60
    Issue number12
    DOIs
    Publication statusPublished - 15 Jun 2015

    Fingerprint

    Melioidosis
    beta-Thalassemia
    Malaysia
    Pediatrics
    Burkholderia pseudomallei
    Chelation Therapy
    Bacteremia
    Iron
    Community-Acquired Infections
    Southeastern Asia
    Fatal Outcome
    Epidemiology
    Chronic Disease
    Retrospective Studies

    Cite this

    Fong, SM ; Wong, Ke ; Fukushima, Masako ; Yeo, Tsin. / Thalassemia Major Is a Major Risk Factor for Pediatric Melioidosis in Kota Kinabalu, Sabah, Malaysia. In: Clinical Infectious Diseases. 2015 ; Vol. 60, No. 12. pp. 1802-1807.
    @article{6ee8eefc3812446f82a0ab5155d1fd51,
    title = "Thalassemia Major Is a Major Risk Factor for Pediatric Melioidosis in Kota Kinabalu, Sabah, Malaysia",
    abstract = "Background: Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.Methods: This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012.Results: Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41{\%}) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59{\%}) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012.Conclusions: Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death. ",
    keywords = "antiinfective agent, adolescent, bacteremia, beta-Thalassemia, Burkholderia pseudomallei, child, complication, female, human, infant, Malaysia, male, melioidosis, mortality, newborn, preschool child, retrospective study, risk factor, treatment outcome, Adolescent, Anti-Bacterial Agents, Bacteremia, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Melioidosis, Retrospective Studies, Risk Factors, Treatment Outcome",
    author = "SM Fong and Ke Wong and Masako Fukushima and Tsin Yeo",
    year = "2015",
    month = "6",
    day = "15",
    doi = "10.1093/cid/civ189",
    language = "English",
    volume = "60",
    pages = "1802--1807",
    journal = "Clinical Infectious Diseases",
    issn = "1058-4838",
    publisher = "Oxford University Press",
    number = "12",

    }

    Thalassemia Major Is a Major Risk Factor for Pediatric Melioidosis in Kota Kinabalu, Sabah, Malaysia. / Fong, SM; Wong, Ke; Fukushima, Masako; Yeo, Tsin.

    In: Clinical Infectious Diseases, Vol. 60, No. 12, 15.06.2015, p. 1802-1807.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Thalassemia Major Is a Major Risk Factor for Pediatric Melioidosis in Kota Kinabalu, Sabah, Malaysia

    AU - Fong, SM

    AU - Wong, Ke

    AU - Fukushima, Masako

    AU - Yeo, Tsin

    PY - 2015/6/15

    Y1 - 2015/6/15

    N2 - Background: Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.Methods: This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012.Results: Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41%) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59%) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012.Conclusions: Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death. 

    AB - Background: Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.Methods: This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012.Results: Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41%) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59%) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012.Conclusions: Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death. 

    KW - antiinfective agent

    KW - adolescent

    KW - bacteremia

    KW - beta-Thalassemia

    KW - Burkholderia pseudomallei

    KW - child

    KW - complication

    KW - female

    KW - human

    KW - infant

    KW - Malaysia

    KW - male

    KW - melioidosis

    KW - mortality

    KW - newborn

    KW - preschool child

    KW - retrospective study

    KW - risk factor

    KW - treatment outcome

    KW - Adolescent

    KW - Anti-Bacterial Agents

    KW - Bacteremia

    KW - Child

    KW - Child, Preschool

    KW - Female

    KW - Humans

    KW - Infant

    KW - Infant, Newborn

    KW - Male

    KW - Melioidosis

    KW - Retrospective Studies

    KW - Risk Factors

    KW - Treatment Outcome

    UR - http://www.scopus.com/inward/record.url?scp=84958699033&partnerID=8YFLogxK

    U2 - 10.1093/cid/civ189

    DO - 10.1093/cid/civ189

    M3 - Article

    VL - 60

    SP - 1802

    EP - 1807

    JO - Clinical Infectious Diseases

    JF - Clinical Infectious Diseases

    SN - 1058-4838

    IS - 12

    ER -