Mohan Anand, Podin Yuwana, Tai Nickson, Chieng Chae-Hee, Rigas Vanessa, 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, Hashim Jamilah, Currie Bart J, Ooi Mong-How
Department of Pediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.
Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
PLoS Negl Trop Dis. 2017 Jun 9;11(6):e0005650. doi: 10.1371/journal.pntd.0005650. eCollection 2017 Jun.
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.
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.
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.
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.
类鼻疽是一种严重的、可能致命的社区获得性感染病，在澳大利亚北部和东南亚（包括马来西亚砂拉越）为地方病。该病由通常对氨基糖苷类药物天然耐药的类鼻疽伯克霍尔德菌引起，最常影响有易感风险因素的成年人。关于砂拉越儿童类鼻疽的资料有限。
2009年至2014年期间，在砂拉越中部的3家主要公立医院对年龄小于15岁、经培养确诊为类鼻疽的儿童进行了一项前瞻性与回顾性相结合的研究。我们研究了流行病学、临床和微生物学特征。
在6年研究期间招募了42例患者。估计15岁以下儿童的总体年发病率为每10万人4.1例，各地区之间存在显著差异。没有儿童有既往病史。23例（55%）患有播散性疾病，其中10例（43%）死亡。最常见的感染部位是肺部，21例（50%）儿童出现肺部感染。其他重要的感染部位包括淋巴结、脾脏、关节和泪腺。7例（17%）儿童有菌血症，无明显感染灶。近90%的儿童存在诊断延迟和类鼻疽适当抗生素治疗延迟的情况。在检测的临床分离株中，35/36（97%）对庆大霉素敏感。其中，所有11株进行基因分型的分离株均为单一多位点序列类型ST881，并具有假定的类鼻疽伯克霍尔德菌毒力决定簇bimABp、fhaB3和YLF基因簇。
砂拉越中部儿童类鼻疽发病率非常高，主要由对庆大霉素敏感的类鼻疽伯克霍尔德菌菌株引起。尽管没有任何明显的易感风险因素，但儿童经常出现播散性疾病，死亡率惊人地高。
