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Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

Mohan A 1 , Manan K 2 , Tan LS 3 , Tan YC 4 , Chin ST 5 , Ahmad R 6 Show all authors , Hamli QI 7 , Chuah TB 8 , Chien SL 9 , Lau PS 10 , Podin Y 11 , Ooi MH 12

Affiliations 

  • 1 Department of Pediatrics, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia; Institute of Health and Community Medicine, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. Electronic address: [email protected]
  • 2 Department of Radiology, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 3 Department of Pathology, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 4 Department of Pediatrics, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 5 Department of Pediatrics, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 6 Department of Pediatrics, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 7 Department of Radiology, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 8 Department of Radiology, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 9 Department of Pathology, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 10 Department of Pediatrics, Bintulu Hospital, Jalan Nyabau, 97000 Bintulu, Sarawak, Malaysia. Electronic address: [email protected]
  • 11 Institute of Health and Community Medicine, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. Electronic address: [email protected]
  • 12 Institute of Health and Community Medicine, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia; Department of Pediatrics, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia. Electronic address: [email protected]
Int J Infect Dis, 2020 Sep;98:59-66.
PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025

Abstract

OBJECTIVES: Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children.

METHODS: We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018.

RESULTS: Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy.

CONCLUSIONS: A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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