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Indian Pediatr 2015;52: 711-712 |
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Pediatric Melioidosis in Southern India
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Chiranjay Mukhopadhyay, *Vandana K Eshwara,
#Pushpa Kini and Vinod Bhat
From Departments of Microbiology and #Pediatrics,
Kasturba Medical College, Manipal University,
Manipal Karnataka, India.
Email: [email protected]
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Melioidosis in children is increasingly detected from the coastal region
of Southern India during monsoon. We present 11 cases of melioidosis,
ranging from localized to disseminated, treated successfully, barring
one death. It calls for awareness and upgrading laboratory facilities
for better diagnosis and management of pediatric melioidosis.
Keywords: Burkholderia pseudomallei,
Child, Lymphadenitis.
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Melioidosis, a disease caused by the soil-dwelling bacterium
Burkholderia pseudomallei, has varied clinical spectrum ranging from
mild localized illness to fulminating sepsis. Southern part of India is
apparently a new ‘hot spot’ in the global map of melioidosis [1,2].
Childhood infections are increasingly being recognized, and are more
localized affecting immunocompetant population [3,4]. This case series
highlights the occurrence and presentation of the culture-confirmed
cases of melioidosis among children, diagnosed at our institute between
January 2007 and June 2014.
Pediatric melioidosis accounted for 8% of 140 cases
of melioidosis diagnosed during this period. The median age was 7.5
years (range 3-18 y). Fever was the commonest presentation (100%) with a
median duration of 10 days (range 2-90 d). Ten children presented with
acute disease ( £2
mo), while one child had fever for three months. Melioidosis was
restricted to head and neck region in five children (two submandibular
abscesses, two suppurative cervical lymphadenitis and one suppurative
parotitis), whereas six had disseminated disease. Hepatomegaly and
splenomegaly were observed in three and two cases, respectively. Two
children had diabetes mellitus, both of whom presented with severe
systemic illness, but recovered. One child, who presented with septic
shock, encephalopathy and acute respiratory distress syndrome (ARDS),
died before blood culture report was available. All except one child
presented during monsoon season (May to October). Nine children were
from coastal regions, and two from around Western Ghats. All children
had history of contact with soil and water while playing outdoor.
Cultures (BacT/ALERT system) showed 100% susceptibility (Kirby Bauer
disc diffusion method) to amoxicillin-clavulanic acid, ceftazidime,
meropenem, sulphamethoxazole-trimethoprim (TMP/SMX) and doxycycline. Six
children were treated with amoxicillin-clavulanic acid, alone or in
combination with ceftazidime or TMP/SMX, while four were treated with
ceftazidime or meropenem. Hospital stay ranged from 3 to 14 days. Ten
children showed clinical improvement by the time of discharge; two
completed 3 months of maintenance therapy with TMP/SMX, and eight were
lost to follow-up.
Melioidosis still remains an underdiagnosed entity in
India, especially in children [4,5]. Acute and localized clinical
presentations involving head and neck as suppurative lymphadenitis is
consistent with other reports from South East Asian countries [2,6-10];
in Australia, suppurative parotitis is more common [1]. Severe systemic
melioidosis in adults or localized melioidosis in children is treated
with intravenous ceftazidime for 10-14 days followed by oral therapy
with TMP/SMX alone or in combination with doxycycline (only in children
>8 years) for 20 weeks. Mild localized infection may be treated with
oral TMP/SMX for shorter duration of 4-5 weeks. Localized melioidosis in
children responds well to drainage of pus supporting better recovery
with short course antibiotic therapy [2,8]. Majority of the children in
our series belonged to rural and semi-urban settings, and presented with
acute disease during rainy season which suggests that waterlogged soil
possibly increases chance of acquiring this infection. However, the
ecology of soil and environmental distribution of B. pseudomallei
is yet to be studied in India.
We conclude that melioidosis should be an important
differential diagnosis in suppurative lesions of head and neck, and soft
tissue infections in children. Active microbiological search would
enhance the accuracy of presumptive diagnosis and widen the knowledge on
this emerging bacterial agent, especially in coastal areas.
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