title: Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature.
abstract: BACKGROUND
  Melioidosis is less common in children than adults. The clinical spectrum of disease varies greatly between the 2 groups. Treatment guidelines are currently based on adult studies, and revision of existing guidelines is necessary to instruct specific pediatric management.
  
  
  METHODS
  Culture-confirmed cases of melioidosis in the Northern Territory between 1989 and 2013 were identified from the Prospective Melioidosis Study. The epidemiology and clinical spectrum of disease for children aged ≤ 16 years were analyzed and compared with the adult data.
  
  
  RESULTS
  Forty-five pediatric patients were identified, representing 5% of the total 820 melioidosis cases over 24 years. Most children (84%) had no recognized risk factors for melioidosis, and 80% presented during the wet season. Primary cutaneous melioidosis was the commonest presentation in children (60% vs 13%; P < .001), whereas pneumonia predominated in adults (54% vs 20%; P < .001). Bacteremia was less common in children than in adults (16% vs 59%; P < .001). Brainstem encephalitis occurred in 3 children without risk factors. Children were more likely to report an inoculating event (42%; P < .001). There was no difference in mortality between the groups (P = .178), with 3 children dying (7%); all had identifiable risk factors. Four children with cutaneous melioidosis were successfully treated with oral therapy alone, while 2 had skin lesions that resolved spontaneously.
  
  
  CONCLUSIONS
  Pediatric melioidosis commonly manifests as localized cutaneous disease in immunocompetent hosts. The disease can be fatal, especially in individuals with risk factors for disease. Melioidosis with encephalomyelitis can result in severe residual disability. Prompt diagnosis requires a high index of clinical suspicion in endemic areas.
authors.affiliation: Pediatric Department, Royal Darwin Hospital.
authors.forename: Charlie
authors.initials: C
authors.lastname: McLeod
authors.affiliation: Pediatric Department, Royal Darwin Hospital.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.affiliation: Pediatric Department, Royal Darwin Hospital.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Bauert
authors.affiliation: Pediatric Department, Royal Darwin Hospital.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Kilburn
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Ward
authors.affiliation: Infectious Diseases Department Pathology Department, Royal Darwin Hospital, Australia.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Baird
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research Infectious Diseases Department.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004679:Encephalomyelitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008554:Melioidosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D015876:Northern Territory / Q000453:epidemiology; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D016019:Survival Analysis
keywords: Burkholderia pseudomallei; cutaneous melioidosis; melioidosis; neuromelioidosis; pediatric