Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics
Background Melioidosis 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...
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| Language: | English |
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PLOS
2017
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| Online Access: | http://ir.unimas.my/id/eprint/17401/ http://ir.unimas.my/id/eprint/17401/1/Pediatric%20melioidosis%20in%20Sarawak%20Malaysia%20%28abstract%29.pdf |
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| author | Anand, Mohan Yuwana, Podin Tai, Nickson Chieng, Chae Hee Vanessa, Rigas Machunter, Barbara Mayo, Mark Wong, Desiree Chien, Su Lin Tan, Lee See Goh, Charles Bantin, Reginal Mijen, Alexander Chua, Wen Yi Hii, King Ching Wong, See Chang Ngian, Hie Ung Wong, Jin Shyan Jamilah, Hashim Currie, Bart J. Ooi, Mong How |
| author_facet | Anand, Mohan Yuwana, Podin Tai, Nickson Chieng, Chae Hee Vanessa, Rigas Machunter, Barbara Mayo, Mark Wong, Desiree Chien, Su Lin Tan, Lee See Goh, Charles Bantin, Reginal Mijen, Alexander Chua, Wen Yi Hii, King Ching Wong, See Chang Ngian, Hie Ung Wong, Jin Shyan Jamilah, Hashim Currie, Bart J. Ooi, Mong How |
| author_sort | Anand, Mohan |
| building | UNIMAS Institutional Repository |
| collection | Online Access |
| description | Background
Melioidosis 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.
Methods
A part prospective, part retrospective study of children aged <15 years with culture-confirmed
melioidosis was conducted in the 3 major public hospitals in Central Sarawak between 2009
and 2014. We examined epidemiological, clinical and microbiological characteristics.
Findings
Forty-two patients were recruited during the 6-year study period. The overall annual incidence
was estimated to be 4.1 per 100,000 children <15 years, with marked variation
between districts. No children had pre-existing medical conditions. Twenty-three (55%) had
disseminated disease, 10 (43%) of whom died. The commonest site of infection was the
lungs, which occurred in 21 (50%) children. Other important sites of infection included lymph
nodes, spleen, joints and lacrimal glands. Seven (17%) children had bacteremia with no overt focus of infection. Delays in diagnosis and in melioidosis-appropriate antibiotic treatment
were observed in nearly 90% of children. Of the clinical isolates tested, 35/36 (97%)
were susceptible to gentamicin. Of these, all 11 isolates that were genotyped were of a single
multi-locus sequence type, ST881, and possessed the putative B. pseudomallei virulence
determinants bimABp, fhaB3, and the YLF gene cluster.
Conclusions
Central 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. |
| first_indexed | 2025-11-15T06:53:02Z |
| format | Article |
| id | unimas-17401 |
| institution | Universiti Malaysia Sarawak |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T06:53:02Z |
| publishDate | 2017 |
| publisher | PLOS |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | unimas-174012017-10-13T01:10:08Z http://ir.unimas.my/id/eprint/17401/ Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics Anand, Mohan Yuwana, Podin Tai, Nickson Chieng, Chae Hee Vanessa, Rigas Machunter, Barbara Mayo, Mark Wong, Desiree Chien, Su Lin Tan, Lee See Goh, Charles Bantin, Reginal Mijen, Alexander Chua, Wen Yi Hii, King Ching Wong, See Chang Ngian, Hie Ung Wong, Jin Shyan Jamilah, Hashim Currie, Bart J. Ooi, Mong How Q Science (General) QR Microbiology R Medicine (General) RJ Pediatrics Background Melioidosis 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. Methods A part prospective, part retrospective study of children aged <15 years with culture-confirmed melioidosis was conducted in the 3 major public hospitals in Central Sarawak between 2009 and 2014. We examined epidemiological, clinical and microbiological characteristics. Findings Forty-two patients were recruited during the 6-year study period. The overall annual incidence was estimated to be 4.1 per 100,000 children <15 years, with marked variation between districts. No children had pre-existing medical conditions. Twenty-three (55%) had disseminated disease, 10 (43%) of whom died. The commonest site of infection was the lungs, which occurred in 21 (50%) children. Other important sites of infection included lymph nodes, spleen, joints and lacrimal glands. Seven (17%) children had bacteremia with no overt focus of infection. Delays in diagnosis and in melioidosis-appropriate antibiotic treatment were observed in nearly 90% of children. Of the clinical isolates tested, 35/36 (97%) were susceptible to gentamicin. Of these, all 11 isolates that were genotyped were of a single multi-locus sequence type, ST881, and possessed the putative B. pseudomallei virulence determinants bimABp, fhaB3, and the YLF gene cluster. Conclusions Central 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. PLOS 2017-06-09 Article PeerReviewed text en http://ir.unimas.my/id/eprint/17401/1/Pediatric%20melioidosis%20in%20Sarawak%20Malaysia%20%28abstract%29.pdf Anand, Mohan and Yuwana, Podin and Tai, Nickson and Chieng, Chae Hee and Vanessa, Rigas and Machunter, Barbara and Mayo, Mark and Wong, Desiree and Chien, Su Lin and Tan, Lee See and Goh, Charles and Bantin, Reginal and Mijen, Alexander and Chua, Wen Yi and Hii, King Ching and Wong, See Chang and Ngian, Hie Ung and Wong, Jin Shyan and Jamilah, Hashim and Currie, Bart J. and Ooi, Mong How (2017) Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics. Neglected Tropical Diseases, 11 (6). ISSN 1935-2735 http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005650 DOI: 10.1371/journal.pntd.0005650 |
| spellingShingle | Q Science (General) QR Microbiology R Medicine (General) RJ Pediatrics Anand, Mohan Yuwana, Podin Tai, Nickson Chieng, Chae Hee Vanessa, Rigas Machunter, Barbara Mayo, Mark Wong, Desiree Chien, Su Lin Tan, Lee See Goh, Charles Bantin, Reginal Mijen, Alexander Chua, Wen Yi Hii, King Ching Wong, See Chang Ngian, Hie Ung Wong, Jin Shyan Jamilah, Hashim Currie, Bart J. Ooi, Mong How Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics |
| title | Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological
characteristics |
| title_full | Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological
characteristics |
| title_fullStr | Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological
characteristics |
| title_full_unstemmed | Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological
characteristics |
| title_short | Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological
characteristics |
| title_sort | pediatric melioidosis in sarawak, malaysia: epidemiological, clinical and microbiological
characteristics |
| topic | Q Science (General) QR Microbiology R Medicine (General) RJ Pediatrics |
| url | http://ir.unimas.my/id/eprint/17401/ http://ir.unimas.my/id/eprint/17401/ http://ir.unimas.my/id/eprint/17401/ http://ir.unimas.my/id/eprint/17401/1/Pediatric%20melioidosis%20in%20Sarawak%20Malaysia%20%28abstract%29.pdf |