Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics

BackgroundMelioidosis is a serious, and potentially fatal community-acquired infection endemic to northern Australia and Southeast Asia, including Sarawak, Malaysia. The disease, caused by the usually intrinsically aminoglycoside-resistant Burkholderia pseudomallei, most commonly affects adults with predisposing risk factors. There are limited data on pediatric melioidosis in Sarawak.MethodsA part prospective, part retrospective study of children aged FindingsForty-two patients were recruited during the 6-year study period. The overall annual incidence was estimated to be 4.1 per 100,000 children B. pseudomallei virulence determinants bimABp, fhaB3, and the YLF gene cluster.ConclusionsCentral Sarawak has a very high incidence of pediatric melioidosis, caused predominantly by gentamicin-susceptible B. pseudomallei strains. Children frequently presented with disseminated disease and had an alarmingly high death rate, despite the absence of any apparent predisposing risk factor.

背景：类鼻疽（Melioidosis）是一种严重且具有潜在致死性的社区获得性感染，流行于澳大利亚北部及东南亚地区，包括马来西亚砂拉越。该病由通常天然耐氨基糖苷类药物的假马勒伯克霍尔德菌（Burkholderia pseudomallei）引发，成人患者多存在易感危险因素。目前砂拉越地区关于儿童类鼻疽的相关数据十分有限。方法：本研究为一项针对儿童的前瞻性与回顾性相结合的研究。结果：在6年的研究周期内共纳入42例患儿，总体年发病率估算为每10万名儿童4.1例。假马勒伯克霍尔德菌的毒力决定簇包括bimABp、fhaB3及YLF基因簇。结论：砂拉越中部地区儿童类鼻疽发病率极高，其致病菌株主要为对庆大霉素敏感的假马勒伯克霍尔德菌（B. pseudomallei）。患儿常表现为播散性感染，即便未发现明确的易感危险因素，其病死率仍高得令人震惊。