title: A retrospective analysis of melioidosis in Cambodian children, 2009-2013.
abstract: Melioidiosis, infection by Burkholderia pseudomallei, is an important but frequently under-recognised cause of morbidity and mortality in Southeast Asia and elsewhere in the tropics. Data on the epidemiology of paediatric melioidosis in Cambodia are extremely limited.
  
  
  
  Culture-positive melioidosis cases presenting to Angkor Hospital for Children, a non-governmental paediatric hospital located in Siem Reap, Northern Cambodia, between 1stJanuary 2009 and 31stDecember 2013 were identified by searches of hospital and laboratory databases and logbooks.
  
  
  
  One hundred seventy-three evaluable cases were identified, presenting from eight provinces. For Siem Reap province, the median commune level incidence was estimated to be 28-35 cases per 100,000 children <15 years per year. Most cases presented during the wet season, May to October. The median age at presentation was 5.7 years (range 8 days-15.9 years). Apart from undernutrition, co-morbidities were rare. Three quarters (131/173) of the children had localised infection, most commonly skin/soft tissue infection (60 cases) or suppurative parotitis (51 cases). There were 39 children with B. pseudomallei bacteraemia: 29 (74.4%) of these had clinical and/or radiological evidence of pneumonia. Overall mortality was 16.8% (29/173) with mortality in bacteraemic cases of 71.8% (28/39). At least seven children did not receive an antimicrobial with activity against B. pseudomallei prior to death.
  
  
  
  This retrospective study demonstrated a considerable burden of melioidosis in Cambodian children. Given the high mortality associated with bacteraemic infection, there is an urgent need for greater awareness amongst healthcare professionals in Cambodia and other countries where melioidosis is known or suspected to be endemic. Empiric treatment guidelines should ensure suspected cases are treated early with appropriate antimicrobials.
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia. pault@tropmedres.ac.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. pault@tropmedres.ac.
authors.forename: Paul
authors.identifier: 0000-0002-1013-7815
authors.initials: P
authors.lastname: Turner
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Sabine
authors.initials: S
authors.lastname: Kloprogge
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Thyl
authors.initials: T
authors.lastname: Miliya
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Sona
authors.initials: S
authors.lastname: Soeng
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Pisey
authors.initials: P
authors.lastname: Tan
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Poda
authors.initials: P
authors.lastname: Sar
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Pagnarith
authors.initials: P
authors.lastname: Yos
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.|Epidemic Diseases Research Group Oxford, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.affiliation: Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Turner
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: David A B
authors.initials: DA
authors.lastname: Dance
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016957:Burkholderia pseudomallei / Q000187:drug effects / Q000472:pathogenicity; D002160:Cambodia / Q000453:epidemiology; D002442:Ceftazidime / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D008554:Melioidosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012621:Seasons; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime
keywords: Cambodia; Melioidosis; Paediatric