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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

McLeod, Charlie, Morris, Peter S., Bauert, Paul A., Kilburn, Charles J., Ward, Linda M., Baird, Robert W. and Currie, Bart J. (2015). 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. Clinical Infectious Diseases,60(1):21-26.

Document type: Journal Article
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IRMA ID 84473293xPUB5
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
Author McLeod, Charlie
Morris, Peter S.
Bauert, Paul A.
Kilburn, Charles J.
Ward, Linda M.
Baird, Robert W.
Currie, Bart J.
Journal Name Clinical Infectious Diseases
Publication Date 2015
Volume Number 60
Issue Number 1
ISSN 1058-4838   (check CDU catalogue  open catalogue search in new window)
Start Page 21
End Page 26
Total Pages 6
Place of Publication United States
Publisher Oxford University Press
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background. 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.

Methods. 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.

Results.
 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.

Conclusions. 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.
Keywords melioidosis
pediatric
Burkholderia pseudomallei
neuromelioidosis
cutaneous melioidosis
DOI http://dx.doi.org/10.1093/cid/ciu733   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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