Clinical and imaging manifestations of pediatric melioidosis in Hainan, China

Abstract

OBJECTIVE: The objective of this study was to investigate the clinical and imaging manifestations of melioidosis in children in Hainan Province, China, to improve its understanding. MATERIALS AND METHODS: We retrospectively analyzed 10 children with melioidosis in Hainan Province, China, from January 2002 to November 2021. We collected clinical and imaging data. These data were analyzed retrospectively by two radiologists with more than 10 years' radiology imaging experience. RESULTS: The patients' average age was 8.4 years (range: 17 days to 15 years), the male-to-female ratio was 6:4, and the average length of hospital stay was 31.5 days (5–96 days). Only two patients had underlying diseases, which were acute lymphocytic leukocyte hepatitis and hepatitis B. One patient had no onset of fever, and the other nine patients had a fever, with an average temperature of 39.5°C (38.4–40.3°C). Two patients had a low white blood cell count (0.27 × 109/L, 3.6 × 109/L), four had a normal white blood cell count, and two had a slightly high white blood cell count (13.6 × 109/L, 14.2 × 109/L). Two patients aged <1 year had a high white blood cell count >34 × 109/L and died. One patient was automatically discharged from the hospital and stopped treatment because of economic factors, and the rest improved after treatment. The neutrophil count was normal in two patients, but it was increased in the other patients. There were no data of C-reactive protein (CRP) measurements in three patients, and four of the other seven patients showed greatly elevated CRP concentrations. Among these four patients, two died and two were cured. One patient had sepsis, three had septicopyemia, and two had multiple organ dysfunction syndrome; among these six patients, one died and others improved. Four patients with pneumonia showed scattered exudation, consolidation, and nodules in both lungs, which developed into lung abscesses, as well as melioidosis and mumps. Three patients showed parotid swelling and abscess formation multilocular. One patient had liver and splenic abscesses. One patient had neck abscesses and one had perineal skin abscesses. One patient had purulent meningitis (clinical diagnosis) and disseminated intravascular coagulation (DIC), and this patient died. CONCLUSIONS: For patients in endemic areas, and those who have clinical manifestations of sepsis, pneumonia, mumps, and liver and splenic abscesses on imaging manifestations, the possibility of melioidosis should be considered. Microbial culture should be carried out as soon as possible, and these results of culture should be considered. Antibiotic treatment should be performed before a diagnosis. Mortality is more likely in patients who are aged <1 year and have considerably elevated CRP concentrations, multiple organ dysfunction syndrome, and central nervous system infection/DIC.