title: Thalassemia major is a major risk factor for pediatric melioidosis in Kota Kinabalu, Sabah, Malaysia.
abstract: BACKGROUND
  Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.
  
  
  METHODS
  This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012.
  
  
  RESULTS
  Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41%) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59%) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012.
  
  
  CONCLUSIONS
  Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death.
authors.affiliation: Division of Pediatric Infectious Diseases, Pediatric Department, Hospital Likas, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Siew M
authors.initials: SM
authors.lastname: Fong
authors.affiliation: Division of Pediatric Infectious Diseases, Pediatric Department, Hospital Likas, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Ke J
authors.initials: KJ
authors.lastname: Wong
authors.affiliation: Division of Pediatric Infectious Diseases, Pediatric Department, Hospital Likas, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Masako
authors.initials: M
authors.lastname: Fukushima
authors.affiliation: Lee Kong Chian School of Medicine, Nanyang Technological University Communicable Diseases Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.
authors.forename: Tsin W
authors.initials: TW
authors.lastname: Yeo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents; D016470:Bacteremia; D016957:Burkholderia pseudomallei; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008554:Melioidosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D017086:beta-Thalassemia / Q000150:complications* / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Burkholderia pseudomallei; iron; melioidosis; pediatric; thalassemia major