Yee-Wah Foong1, Natalie Woon-Hui Tan2,3,4, Chia-Yin Chong2,3,4, Koh-Cheng Thoon2,3,4, Nancy Wen-Sim Tee4,5, Mark Jean-Aan Koh1. 1. Dermatology Service, KK Women's and Children's Hospital, Singapore. 2. Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore. 3. Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore. 4. Duke-NUS Graduate Medical School , Singapore. 5. Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore.
Abstract
BACKGROUND: Melioidosis, caused by Burkholderia pseudomallei, is endemic in Singapore and can present as localized or disseminated disease. METHODS: Demographic data, clinical features, investigation results, treatments, and outcomes in patients aged <16 years diagnosed with melioidosis at KK Women's and Children's Hospital between January 2002 and January 2014 were retrospectively reviewed. Data for patients with primary skin disease and those with other organ involvement were compared. RESULTS: Seventeen children were diagnosed with melioidosis. Their median age was 12.5 years (range: 2-15 years). Nine (53%) patients presented with localized cutaneous melioidosis and five (29%) with localized lymphadenitis, pneumonia, or septic arthritis. The remaining three (18%) patients had melioidosis sepsis; two of these patients died from septic shock. Treatment included an initial 1-2 weeks of IV antibiotics followed by 3-6 months of oral combination antibiotics. All cases of localized cutaneous disease resolved completely with no recurrences. Three (60%) of the five patients with localized involvement of other organ systems achieved complete resolution of disease, and the remaining two were lost from follow-up. CONCLUSIONS: Although uncommon, melioidosis can occur in children living in endemic regions. Patients with localized skin disease have good outcomes with no recurrences. Systemic disease can be fatal, especially in the presence of underlying immunodeficiency. Diagnosis requires a high index of suspicion, and treatment requires prolonged combination antibiotic therapy.
BACKGROUND:Melioidosis, caused by Burkholderia pseudomallei, is endemic in Singapore and can present as localized or disseminated disease. METHODS: Demographic data, clinical features, investigation results, treatments, and outcomes in patients aged <16 years diagnosed with melioidosis at KK Women's and Children's Hospital between January 2002 and January 2014 were retrospectively reviewed. Data for patients with primary skin disease and those with other organ involvement were compared. RESULTS: Seventeen children were diagnosed with melioidosis. Their median age was 12.5 years (range: 2-15 years). Nine (53%) patients presented with localized cutaneous melioidosis and five (29%) with localized lymphadenitis, pneumonia, or septic arthritis. The remaining three (18%) patients had melioidosis sepsis; two of these patients died from septic shock. Treatment included an initial 1-2 weeks of IV antibiotics followed by 3-6 months of oral combination antibiotics. All cases of localized cutaneous disease resolved completely with no recurrences. Three (60%) of the five patients with localized involvement of other organ systems achieved complete resolution of disease, and the remaining two were lost from follow-up. CONCLUSIONS: Although uncommon, melioidosis can occur in children living in endemic regions. Patients with localized skin disease have good outcomes with no recurrences. Systemic disease can be fatal, especially in the presence of underlying immunodeficiency. Diagnosis requires a high index of suspicion, and treatment requires prolonged combination antibiotic therapy.
Authors: Siew Hoon Sim; Catherine Ee Ling Ong; Yunn Hwen Gan; Dongling Wang; Victor Wee Hong Koh; Yian Kim Tan; Michelle Su Yen Wong; Janet Seok Wei Chew; Sian Foong Ling; Brian Zi Yan Tan; Agnes Zhengyu Ye; Patrick Chuan Kiat Bay; Wai Kwan Wong; Charlene Judith Fernandez; Shangzhe Xie; Praveena Jayarajah; Tasha Tahar; Pei Yee Oh; Sonja Luz; Jaime Mei Fong Chien; Thuan Tong Tan; Louis Yi Ann Chai; Dale Fisher; Yichun Liu; Jimmy Jin Phang Loh; Gladys Gek Yen Tan Journal: Trop Med Infect Dis Date: 2018-03-12