ESPID Reports and Reviews CONTENTS Melioidosis Intussusception and Rotavirus Vaccines

EDITORIAL BOARD Co-Editors:  Delane Shingadia  and Irja Lutsar Board Members David Burgner (Melbourne, Australia) Luisa Galli (Florence, Italy) Christiana Nascimento-Carvalho (Bahia, Brazil) Ville Peltola (Turku, Finland)

Nicole Ritz (Basel, Switzerland) Ira Shah (Mumbai, India) Matthew Snape (Oxford, UK) George Syrogiannopoulos (Larissa, Greece)

Tobias Tenenbaum (Mannhein, Germany) Marc Tebruegge (Southampton, UK) Marceline van Furth (Amsterdam, The Netherlands) Anne Vergison (Brussels, Belgium)

Melioidosis A Pediatric Disease Christine Sanderson, FRACP* and Bart J. Currie, FRACP†

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elioidosis is recognized as a pediatric disease in the endemic regions of tropical South East Asia and Northern Australia. Children with this potentially life-threatening infection, caused by Burkholderia pseudomallei, may also present in nonendemic areas, and thus awareness of the disease spectrum is important for all involved in pediatric acute care. This review discusses the epidemiology, range of clinical presentation and management of melioidosis in children. A comprehensive review of recent progress in the understanding of the pathogenesis and diagnostics of melioidosis is available elsewhere.1

EPIDEMIOLOGY In endemic regions, B. pseudomallei is found in the surface water and soil, and transmission of the bacteria to humans occurs through local inoculation, inhalation, aspiration and ingestion.2 Increased disease frequency is seen in the tropical wet season and after severe weather events.3 Although From the *Barwon Health and Deakin University Medical School, Geelong, Victoria, Australia; and †Menzies School of Health Research and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia The authors have no funding or conflicts of interest to disclose. Address for correspondence: Christine Sanderson, FRACP, Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia. E-mail: [email protected]. Copyright © 2014 by Lippincott Williams & Wilkins ISSN: 0891-3668/14/3307-0770 DOI: 10.1097/INF.0000000000000358

most data are from Thai and Australian studies, case reports are emerging from tropical regions, including the Americas and Africa, which confirm wider endemicity.4,5 Melioidosis has a broad spectrum of clinical disease in children, as in adults. Indeed many infections result in asymptomatic infection, reflected by the high seroprevalence in young children noted in Thailand.6 Melioidosis is characterized as a febrile illness and is an important cause of acute overwhelming septicemia, but less virulent forms, ranging from indolent chronic localized skin infection to abscess formation are also common. Nearly all tissues can be affected, with the lung, spleen and liver being most common. Melioidosis is recognized as a leading cause of bacterial sepsis in children in regions of Thailand and potentially also Cambodia.7 There is a high mortality in both children and adults, which could be reduced with greater awareness, improved diagnostic investigations and early appropriate treatment.3 Many endemic areas of South East Asia are resource-poor and lack diagnostic and medical facilities.

THE FREQUENCY AND DIFFERENT SPECTRUM OF CLINICAL PRESENTATIONS IN CHILDREN Children