Hepatic/splenic abscess and/or skin and soft tissue infection as predictors of melioidosis in children

  • Supatjaree Chanvitan Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
  • Alan Geater Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
  • Kamolwish Laoprasopwattana Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
Keywords: Burkholderia pseudomallei, melioidosis, liver abscess, splenic abscess, soft tissue infection

Abstract

Introduction: Melioidosis can have multiple organ involvement which can then mimic other infections. The aim of this study was to determine if there are any factors significantly associated with melioidosis which can inform diagnostic evaluations before receiving the results of confirming laboratory testing.

Methodology: The charts of patients aged < 16 years admitted to Songklanagarind Hospital during 2002-2014 with a clinical presentation suspicious of melioidosis were reviewed.

Results: Of the 145 suspected cases, 27 patients had a confirmed diagnosis of melioidosis by either serology and/or culture. The melioidosis group had a higher proportion of patients with liver or splenic abscess (44.4% vs. 11.9%, p < 0.01) and were less likely to have splenomegaly by physical examination (3.7% vs. 22.9%, p = 0.02) than patients without melioidosis. Logistic regression analysis found that patients suspected of melioidosis who had (a) hepatic abscess or (b) splenic abscess or (c) skin or soft tissue infection were more likely to have melioidosis with likelihood ratios of 5.6, 4.0, and 2.2 respectively, and specificities of 0.94, 0.89, and 0.68 respectively. Suspected patients who did not have hepatic abscess, splenic abscess, or soft tissue infection were unlikely to have melioidosis with negative predictive value of 0.90.

Conclusion: patients who have clinically suspected melioidosis without skin or soft tissue infection should have hepatic-splenic ultrasonography performed, and suspected patients who have one of these 3 findings should be treated initially as melioidosis while waiting for culture or serologic test results.

Published
2019-02-28
How to Cite
1.
Chanvitan S, Geater A, Laoprasopwattana K (2019) Hepatic/splenic abscess and/or skin and soft tissue infection as predictors of melioidosis in children. J Infect Dev Ctries 13:149-153. doi: https://doi.org/10.3855/jidc.10727
Section
Original Articles