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Simplified Whole Body Plethysmography to Characterize Lung Function During Respiratory Melioidosis
Published on: February 24, 2023
Melioidosis in children: a retrospective study
Yee-Wah Foong1, Natalie Woon-Hui Tan2,3,4, Chia-Yin Chong2,3,4
1Dermatology Service, KK Women's and Children's Hospital, Singapore.
Background:
Melioidosis, caused by Burkholderia pseudomallei, is endemic in Singapore and can present as localized or disseminated disease.
Methods:
Demographic data, clinical features, investigation results, treatments, and outcomes in patients aged <16 years diagnosed with melioidosis at KK Women's and Children's Hospital between January 2002 and January 2014 were retrospectively reviewed. Data for patients with primary skin disease and those with other organ involvement were compared.
Results:
Seventeen children were diagnosed with melioidosis. Their median age was 12.5 years (range: 2-15 years). Nine (53%) patients presented with localized cutaneous melioidosis and five (29%) with localized lymphadenitis, pneumonia, or septic arthritis. The remaining three (18%) patients had melioidosis sepsis; two of these patients died from septic shock. Treatment included an initial 1-2 weeks of IV antibiotics followed by 3-6 months of oral combination antibiotics. All cases of localized cutaneous disease resolved completely with no recurrences. Three (60%) of the five patients with localized involvement of other organ systems achieved complete resolution of disease, and the remaining two were lost from follow-up.
Conclusions:
Although uncommon, melioidosis can occur in children living in endemic regions. Patients with localized skin disease have good outcomes with no recurrences. Systemic disease can be fatal, especially in the presence of underlying immunodeficiency. Diagnosis requires a high index of suspicion, and treatment requires prolonged combination antibiotic therapy.
Insights
Melioidosis in children, caused by Burkholderia pseudomallei, is uncommon but serious. Localized skin infections have good outcomes, but systemic disease can be fatal, necessitating prompt diagnosis and prolonged antibiotic treatment.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
- Public Health Epidemiology
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is an endemic infectious disease in Singapore.
- The disease can manifest in localized or disseminated forms, posing diagnostic challenges.
Purpose of the Study:
- To investigate the clinical characteristics, treatment, and outcomes of pediatric melioidosis cases.
- To compare outcomes between patients with primary cutaneous melioidosis and those with other organ involvement.
Main Methods:
- Retrospective review of demographic, clinical, and treatment data for pediatric patients (<16 years) diagnosed with melioidosis.
- Analysis of data from KK Women's and Children's Hospital between January 2002 and January 2014.
- Comparison of disease presentation and outcomes based on affected organ systems.
Main Results:
- Seventeen children were diagnosed with melioidosis, with a median age of 12.5 years.
- Localized cutaneous melioidosis (53%) and localized lymphadenitis/pneumonia/septic arthritis (29%) were common presentations.
- Systemic melioidosis sepsis occurred in 18% of cases, with two deaths attributed to septic shock.
Conclusions:
- Melioidosis is an uncommon but significant concern in children residing in endemic areas.
- Localized cutaneous melioidosis demonstrates excellent prognosis with no recurrences.
- Systemic disease carries a high mortality risk, particularly in immunocompromised children, emphasizing the need for high clinical suspicion and extended combination antibiotic therapy.
