Related Experiment Videos
Childhood melioidosis in northeastern Thailand
V Pongrithsukda1, N Simakachorn, J Pimda
1Department of Pediatrics, Maharaj Nakhon Ratchasima Hospital, Thailand.
Abstract:
Eighteen cases of childhood melioidosis in Northeastern Thailand were reviewed. The mean age was 6.8 years with a range from eight months to 15 years. Twelve cases (66.7%) had localized melioidosis, six of which had pneumonia. Three patients were diagnosed as pharyngocervical melioidosis, the newly recognized syndrome. Nine cases (50.0%) had associated diseases including dengue hemorrhagic fever (DHF) in five cases. In all five cases, melioidosis was diagnosed during the convalescent stage as a cause of pyrexia with or without pneumonia. Pseudomonas pseudomallei strains isolated from 12 patients were all sensitive to chloramphenicol, cotrimoxazole and kanamycin. Ceftazidime, cefotaxime and ceftriaxone were also active against all six isolates tested. Three cases died, all were diagnosed as disseminated septicaemic melioidosis at postmortem. The overall mortality rate was 16.7%. The septicaemic form of melioidosis can resemble many diseases such as septicaemia due to Staphylococcus aureus or gram-negative organisms other than P. pseudomallei while the localized from may mimic pulmonary tuberculosis. A high index of clinical suspicion is required in making a diagnosis of melioidosis, particularly in areas where the disease is endemic.
Insights
Childhood melioidosis in Thailand presents with localized or pharyngocervical forms, often with co-occurring diseases like dengue hemorrhagic fever. Early diagnosis and treatment are crucial due to a significant mortality rate, especially in disseminated cases.
Area of Science:
- Infectious Diseases
- Pediatrics
- Microbiology
Background:
- Melioidosis, caused by Pseudomonas pseudomallei, is an emerging infectious disease in tropical regions.
- Childhood melioidosis is less understood, with varied clinical presentations and potential for severe outcomes.
Purpose of the Study:
- To review and characterize cases of childhood melioidosis in Northeastern Thailand.
- To identify clinical features, associated diseases, treatment sensitivities, and outcomes.
Main Methods:
- Retrospective review of 18 childhood melioidosis cases.
- Analysis of clinical data, microbiological findings, and patient outcomes.
- Assessment of antibiotic susceptibility of isolated Pseudomonas pseudomallei strains.
Main Results:
- The mean age was 6.8 years; 66.7% had localized melioidosis, including pneumonia.
- Pharyngocervical melioidosis was identified as a distinct syndrome.
- 50% of cases had associated diseases, notably dengue hemorrhagic fever (DHF).
- Antibiotics like chloramphenicol, cotrimoxazole, and cephalosporins showed sensitivity.
- Overall mortality was 16.7%, with disseminated septicemic melioidosis being fatal.
Conclusions:
- Childhood melioidosis exhibits diverse presentations, including a newly recognized pharyngocervical form.
- Co-infection with DHF can complicate diagnosis, especially during the convalescent phase.
- High clinical suspicion is vital for early diagnosis and management in endemic areas.