McLeod C; Morris, Peter; Bauert, Paul; Kilburn, Charles; Ward LM; Baird, Robert; Currie, Bart

Author(s)

McLeod C

Morris, Peter

Bauert, Paul

Kilburn, Charles

Ward LM

Baird, Robert

Currie, Bart

Publication Date

2015-01-01

Abstract

Melioidosis is less common in children than adults. The clinical spectrum of disease varies greatly between the 2 groups. Treatment guidelines are currently based on adult studies, and revision of existing guidelines is necessary to instruct specific pediatric management. Culture-confirmed cases of melioidosis in the Northern Territory between 1989 and 2013 were identified from the Prospective Melioidosis Study. The epidemiology and clinical spectrum of disease for children aged ≤ 16 years were analyzed and compared with the adult data. Forty-five pediatric patients were identified, representing 5% of the total 820 melioidosis cases over 24 years. Most children (84%) had no recognized risk factors for melioidosis, and 80% presented during the wet season. Primary cutaneous melioidosis was the commonest presentation in children (60% vs 13%; P < .001), whereas pneumonia predominated in adults (54% vs 20%; P < .001). Bacteremia was less common in children than in adults (16% vs 59%; P < .001). Brainstem encephalitis occurred in 3 children without risk factors. Children were more likely to report an inoculating event (42%; P < .001). There was no difference in mortality between the groups (P = .178), with 3 children dying (7%); all had identifiable risk factors. Four children with cutaneous melioidosis were successfully treated with oral therapy alone, while 2 had skin lesions that resolved spontaneously. Pediatric melioidosis commonly manifests as localized cutaneous disease in immunocompetent hosts. The disease can be fatal, especially in individuals with risk factors for disease. Melioidosis with encephalomyelitis can result in severe residual disability. Prompt diagnosis requires a high index of clinical suspicion in endemic areas.

Affiliation

Pediatric Department, Royal Darwin Hospital..

Global and Tropical Health Division, Menzies School of Health Research..

Infectious Diseases Department Pathology Department, Royal Darwin Hospital, Australia..

Global and Tropical Health Division, Menzies School of Health Research Infectious Diseases Department..

Citation

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2015-01-01; 60(1): 21-6

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/25228703/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/5558

Subject

Burkholderia pseudomallei

cutaneous melioidosis

melioidosis

neuromelioidosis

pediatric

MESH subject

Adolescent

Adult

Child

Child, Preschool

Encephalomyelitis

Female

Humans

Infant

Male

Melioidosis

Northern Territory

Prospective Studies

Skin

Survival Analysis

Title

Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature.

Type of document

Journal Article

Entity Type

Publication

Author(s)	McLeod C Morris, Peter Bauert, Paul Kilburn, Charles Ward LM Baird, Robert Currie, Bart
Publication Date	2015-01-01
Abstract	Melioidosis is less common in children than adults. The clinical spectrum of disease varies greatly between the 2 groups. Treatment guidelines are currently based on adult studies, and revision of existing guidelines is necessary to instruct specific pediatric management. Culture-confirmed cases of melioidosis in the Northern Territory between 1989 and 2013 were identified from the Prospective Melioidosis Study. The epidemiology and clinical spectrum of disease for children aged ≤ 16 years were analyzed and compared with the adult data. Forty-five pediatric patients were identified, representing 5% of the total 820 melioidosis cases over 24 years. Most children (84%) had no recognized risk factors for melioidosis, and 80% presented during the wet season. Primary cutaneous melioidosis was the commonest presentation in children (60% vs 13%; P < .001), whereas pneumonia predominated in adults (54% vs 20%; P < .001). Bacteremia was less common in children than in adults (16% vs 59%; P < .001). Brainstem encephalitis occurred in 3 children without risk factors. Children were more likely to report an inoculating event (42%; P < .001). There was no difference in mortality between the groups (P = .178), with 3 children dying (7%); all had identifiable risk factors. Four children with cutaneous melioidosis were successfully treated with oral therapy alone, while 2 had skin lesions that resolved spontaneously. Pediatric melioidosis commonly manifests as localized cutaneous disease in immunocompetent hosts. The disease can be fatal, especially in individuals with risk factors for disease. Melioidosis with encephalomyelitis can result in severe residual disability. Prompt diagnosis requires a high index of clinical suspicion in endemic areas.
Affiliation	Pediatric Department, Royal Darwin Hospital.. Pediatric Department, Royal Darwin Hospital.. Pediatric Department, Royal Darwin Hospital.. Pediatric Department, Royal Darwin Hospital.. Global and Tropical Health Division, Menzies School of Health Research.. Infectious Diseases Department Pathology Department, Royal Darwin Hospital, Australia.. Global and Tropical Health Division, Menzies School of Health Research Infectious Diseases Department..
Citation	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2015-01-01; 60(1): 21-6
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/25228703/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/5558
Subject	Burkholderia pseudomallei cutaneous melioidosis melioidosis neuromelioidosis pediatric
MESH subject	Adolescent Adult Child Child, Preschool Encephalomyelitis Female Humans Infant Male Melioidosis Northern Territory Prospective Studies Skin Survival Analysis
Title	Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature.
Type of document	Journal Article
Entity Type	Publication

Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature.

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