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Updated: Feb 28, 2026
Simplified Whole Body Plethysmography to Characterize Lung Function During Respiratory Melioidosis
Published on: February 24, 2023
Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics
Anand Mohan1, Yuwana Podin2,3, Nickson Tai4
1Department of Pediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.
Background:
Melioidosis is a serious, and potentially fatal community-acquired infection endemic to northern Australia and Southeast Asia, including Sarawak, Malaysia. The disease, caused by the usually intrinsically aminoglycoside-resistant Burkholderia pseudomallei, most commonly affects adults with predisposing risk factors. There are limited data on pediatric melioidosis in Sarawak.
Methods:
A part prospective, part retrospective study of children aged <15 years with culture-confirmed melioidosis was conducted in the 3 major public hospitals in Central Sarawak between 2009 and 2014. We examined epidemiological, clinical and microbiological characteristics.
Findings:
Forty-two patients were recruited during the 6-year study period. The overall annual incidence was estimated to be 4.1 per 100,000 children <15 years, with marked variation between districts. No children had pre-existing medical conditions. Twenty-three (55%) had disseminated disease, 10 (43%) of whom died. The commonest site of infection was the lungs, which occurred in 21 (50%) children. Other important sites of infection included lymph nodes, spleen, joints and lacrimal glands. Seven (17%) children had bacteremia with no overt focus of infection. Delays in diagnosis and in melioidosis-appropriate antibiotic treatment were observed in nearly 90% of children. Of the clinical isolates tested, 35/36 (97%) were susceptible to gentamicin. Of these, all 11 isolates that were genotyped were of a single multi-locus sequence type, ST881, and possessed the putative B. pseudomallei virulence determinants bimABp, fhaB3, and the YLF gene cluster.
Conclusions:
Central Sarawak has a very high incidence of pediatric melioidosis, caused predominantly by gentamicin-susceptible B. pseudomallei strains. Children frequently presented with disseminated disease and had an alarmingly high death rate, despite the absence of any apparent predisposing risk factor.
Insights
Pediatric melioidosis in Sarawak is highly prevalent and severe, with disseminated disease and high mortality rates in children. Most infections were caused by gentamicin-susceptible Burkholderia pseudomallei strains, highlighting diagnostic and treatment delays.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Microbiology
Background:
- Melioidosis is a severe, potentially fatal infection endemic to Southeast Asia, including Sarawak, Malaysia.
- Caused by Burkholderia pseudomallei, it typically affects adults with risk factors, with limited data on pediatric cases in Sarawak.
Purpose of the Study:
- To investigate the epidemiological, clinical, and microbiological characteristics of pediatric melioidosis in Central Sarawak.
- To determine the incidence and outcomes of melioidosis in children under 15 years old.
Main Methods:
- A part prospective, part retrospective study of children (<15 years) with culture-confirmed melioidosis.
- Data collected from 2009-2014 across three major public hospitals in Central Sarawak.
Main Results:
- Forty-two pediatric cases were identified, estimating an annual incidence of 4.1 per 100,000 children.
- Disseminated disease occurred in 55% of cases, with a 43% mortality rate; lung infection was most common.
- Nearly 90% experienced diagnostic and treatment delays; most isolates were susceptible to gentamicin (97%).
Conclusions:
- Central Sarawak exhibits a very high incidence of pediatric melioidosis, predominantly caused by gentamicin-susceptible B. pseudomallei.
- Children often presented with disseminated disease and had a high mortality rate, irrespective of predisposing factors.
