Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10573
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.
Authors: McLeod, Charlie
Morris, Peter S
Bauert, Paul A
Kilburn, Charles J
Ward, Linda M
Baird, Robert W
Currie, Bart J
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..
Issue Date: 1-Jan-2015
Citation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2015-01-01; 60(1): 21-6
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.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10573
DOI: 10.1093/cid/ciu733
Type: Journal Article
Research Support, Non-U.S. Gov't
Review
Subjects: Burkholderia pseudomallei
cutaneous melioidosis
melioidosis
neuromelioidosis
pediatric
Adolescent
Adult
Child
Child, Preschool
Encephalomyelitis
Female
Humans
Infant
Male
Melioidosis
Northern Territory
Prospective Studies
Skin
Survival Analysis
Appears in Collections:NT Health digital library

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