Fatal Pediatric Melioidosis and the Role of Hyperferritinemic Sepsis-Induced Multiple-Organ Dysfunction Syndrome

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  • 1 Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia;
  • | 2 Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia;
  • | 3 Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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Melioidosis is reported to cause a high fatality rate in children, even in the absence of risk factors for disease. The aim of this study was to identify characteristics of fatal pediatric melioidosis infection. We performed a retrospective analysis of children aged < 15 years with culture-confirmed melioidosis admitted to Bintulu Hospital in Sarawak, Malaysian Borneo, from January 2011 to December 2020. Forty-one children had culture-confirmed melioidosis. Nine (22%) had a fatal outcome; 8 (89%) had no predisposing risk factors. Bacteremia, septic shock, and acute respiratory distress syndrome were present in all fatalities. Demographic characteristics, presenting manifestation, and disseminated infection were not significantly associated with mortality, whereas the presence of splenomegaly, cytopenia, disseminated intravascular coagulation, and hepatobiliary disease, all of which are features of hyperferritinemic sepsis-induced multiple-organ dysfunction syndrome, were associated with mortality. Hyperferritinemic sepsis-induced multiple-organ dysfunction syndrome may be a key component in the pathogenesis of fatal pediatric melioidosis.

Author Notes

Address correspondence to Anand Mohan, Hospital Bintulu, Jalan Nyabau, Bintulu 97000, Sarawak, Malaysia. E-mail: anand_bintulu@yahoo.com

Authors’ addresses: Anand Mohan, Malini Paranchothy, Sakthy Segaran, and Richard Siu-Chiu Wong, Department of Pediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia, E-mails: anand_bintulu@yahoo.com, malni91@hotmail.com, sakthy.segaran@gmail.com, and richard_wong82@hotmail.com. Yek-Kee Chor and Mong-How Ooi, Department of Pediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia, E-mails: drchoryekee@hotmail.com and monghowooi@gmail.com. Yuwana Podin, Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia, E-mail: pyuwana@unimas.my.

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