Case Report: Fatal Pediatric Melioidosis Despite Optimal Intensive Care

Young, Alice; Tacon, Catherine; Smith, Simon; Reeves, Ben; Wiseman, Greg; Hanson, Josh

doi:10.4269/ajtmh.17-0650

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…The higher rates may be partly explained by fewer diagnoses of cutaneous disease in rural and remote communities; however, skin swab samples are frequently taken to identify other pathogens, and skin and soft tissue B. pseudomallei infections are uncommon in urban areas, where most new cases have been identified ( 12 ). Virulence factors in local B. pseudomallei strains may contribute ( 13 ). Despite the increasing incidence, the overall case-fatality rate from melioidosis in FNQ decreased significantly during the study period, which can probably be explained by early recognition and prompt access to multimodal intensive care unit support.…”

Section: Discussionmentioning

confidence: 99%

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

Smith¹,

Horne²,

Rubenach³

et al. 2021

Emerg. Infect. Dis.

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Section: Discussionmentioning

confidence: 99%

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

Smith¹,

Horne²,

Rubenach³

et al. 2021

Emerg. Infect. Dis.

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“…The role of imaging, apart from identification of the presence of abscess in the liver, can potentially be extended to help in early appropriate treatment of melioidosis by identifying the causative organism with the help of the honeycomb sign before microbiological confirmation as delayed or ineffective treatment can lead to fatal outcome. [19][20][21] The treatment of melioidosis differs from other pyogenic infections in that an intensive phase of treatment with effective antibiotics lasting for 10 days or more followed by an eradication phase of at least 12 weeks, potentially 20 weeks is required to completely eliminate the organism from the bloodstream, thus avoiding relapses. 22 Effective antibiotics for intensive therapy include parenteral ceftazidime, amoxicillin-clavulanic acid, or meropenem; for the eradication phase, oral trimethoprimsulfamethoxazole is used.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

Khiangte

Vimala

Eapen

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Among pyogenic liver abscesses, melioid etiology is considered in endemic regions in the presence of known health or occupational risk factors. "Honeycomb sign," used to describe an abscess with multiple internal septations dividing the abscess cavity into multiple loculations of comparable sizes on imaging, is a sensitive sign for melioid liver abscess. This is a retrospective case-control study investigating incidence, sensitivity, and specificity of "honeycomb sign" in melioid liver abscess, in a cohort of patients with culture-proven melioidosis infection. Abscesses ≥ 2 cm were analyzed for the honeycomb sign. value< 0.05 was taken as statistically significant. Interobserver agreement was calculated between two radiologists for the presence of the sign, sensitivity, and specificity. A total of 40 abscesses were analyzed. Thirty-four abscesses (85%) manifested the honeycomb sign with interobserver agreement (kappa = 0.70 and 0.92). Sensitivity of the sign is 85% (95% confidence interval [CI]: 70-94%), specificity is 75% (95% CI: 59-87%), positive predictive value is 77% (95% CI: 62-88%), and negative predictive value is 83% (95% CI: 67-94%). If abscess size is ≥ 3 cm, the sensitivity is 91% (95% CI: 77-98%), specificity is 75% (95% CI: 59-87%), positive predictive value is 76% (95% CI: 61-88%), and negative predictive value is 91% (95% CI: 76-98%). Honeycomb sign is a novel imaging marker for melioid liver abscess. Increased awareness and recognition of this imaging feature has the potential to affect patient management.

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“…In contrast to Southeast Asia, acute suppurative parotitis is extremely rare in Australia [ 5 ], which is likely related to ingestion being an uncommon mode of transmission. Case-fatality rates in Darwin children are comparable to that of adults but, in FNQ, the rates of bacteraemia and mortality are much higher—60% and 50%, respectively—with fatal cases occurring despite optimal treatment [ 51 , 52 ]. The explanation for this observation is uncertain, although it may be partly explained by less active case finding in FNQ.…”

Section: Melioidosis Cases and The Presence Of B Pseudomentioning

confidence: 99%

Melioidosis: An Australian Perspective

2018

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Burkholderia pseudomallei is endemic in northern Australia, with cases of melioidosis most commonly occurring during the wet season in individuals with diabetes, hazardous alcohol use, and chronic kidney disease. Pneumonia is the most common presentation and the majority of patients are bacteraemic—however, infection may involve almost any organ, with the skin and soft tissues, genitourinary system, visceral organs, and bone and joints affected most commonly. Central nervous system involvement is rarer, but has a high attributable mortality. Increased awareness of the disease amongst healthcare providers, ready access to appropriate antibiotic therapy and high-quality intensive care services has resulted in a sharp decline in the case fatality rate over the last 20 years. Further improvement in clinical outcomes will require a greater understanding of the disease′s pathophysiology, its optimal management, and more effective strategies for its prevention.

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Case Report: Fatal Pediatric Melioidosis Despite Optimal Intensive Care

Cited by 12 publications

References 15 publications

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

Melioidosis: An Australian Perspective

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