Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

Abstract

We describe the first cases of pediatric melioidosis in Cambodia. Thirty-nine cases were diagnosed at the Angkor Hospital for Children, Siem Reap, between October 2005 and December 2008 after the introduction of microbiology capabilities. Median age was 7.8 years (range = 1.6–16.2 years), 15 cases were male (38%), and 4 cases had pre-existing conditions that may have pre-disposed the patient to melioidosis. Infection was localized in 27 cases (69%) and disseminated in 12 cases (31%). Eleven cases (28%) were treated as outpatients, and 28 (72%) cases were admitted. Eight children (21%) died a median of 2 days after admission; seven deaths were attributable to melioidosis, all of which occurred in children receiving suboptimal antimicrobial therapy and before bacteriological culture results were available. Our findings indicate the need for heightened awareness of melioidosis in Cambodia, and they have led us to review microbiology procedures and antimicrobial prescribing of suspected and confirmed cases.

A retrospective analysis of melioidosis in Cambodian children, 2009–2013

“…The data presented confirms the initial findings regarding paediatric melioidosis in Cambodia [6, 11, 13]. The majority of cases occurred in the monsoon season, were localised infections, and most children did not have underlying co-morbidities.…”

“…A microbiology laboratory is located at the main hospital and specimens are transported from the satellite clinic for processing on a daily basis. Microbiology specimens are routinely processed to identify B. pseudomallei infection as previously described [11]. Briefly, 1–4 ml blood specimens are cultured for up to 7 days in 20 ml tryptone soya broth (Oxoid, UK) plus 0.05% sodium polyanethol sulphonate (Sigma-Aldrich, UK).…”

“…Cases were defined as localised or disseminated as described elsewhere [11]. Briefly, localised infection was defined as a single anatomic focus of infection whereas disseminated infection was defined as localised infection in two or more discrete anatomic areas and/or B. pseudomallei bacteraemia.…”

“…Vlieghe and colleagues described 58 adult cases presenting to a single hospital in the capital, Phnom Penh, between July 2007 and January 2010 [10]. Angkor Hospital for Children (AHC), a non-governmental hospital located in Siem Reap province, identified a total of 39 paediatric melioidosis cases over an overlapping time period (October 2005 to December 2008), following the opening of a diagnostic microbiology laboratory within the hospital [11]. Although these figures are lower than the numbers of cases seen annually in neighbouring Thailand [12], more recently, B. pseudomallei has been reported to account for 74% of suppurative parotitis [6], and 7.9% of culture-positive bacteraemia [13] seen in AHC, further evidence that melioidosis is likely to have been grossly underdiagnosed in Cambodia.…”

“Melioidosis in Antioquia, Colombia: an emerging or endemic disease? A cases series”

“…[12][13][14][15][16][17][18] In Colombia, there have been only two published cases of nonbacteremic melioidosis. 13,14 In endemic areas, the peak incidence is between 40 and 60 years 19 and epidemics are associated with the winter or rainy season. B. pseudomallei is usually found in shallow waters and in damp soil between 25 and 45 cm deep.…”