Publish Time: 2023-08-21 Origin: 迪飞医学
The team of Professor Li Yuchuan from the Department of Infectious Diseases of the Children's Hospital of Fudan University cooperated with Diffei Medical to treat a case of Burkholderia pseudomallei sepsis in a child.[1].The peripheral blood of the child was sent to Diffei Medical Laboratory for testing, and mNGS quickly identified Burkholderia pseudomallei.
This case was Burkholderia pseudomallei sepsis in a child in a non-endemic area. The child's brother died from the same disease.Burkholderia pseudomallei sepsis is relatively rare in children and has a high mortality rate. Although it is rare in non-endemic areas, it should be highly valued clinically, and etiological examination should be completed as soon as possible and active anti-infective treatment should be given.This case has been included in the 'Chinese Clinical Case Results Database'.
A case of Burkholderia pseudomallei sepsis in a child
Sepsis is a syndrome of a series of pathological, physiological and biochemical abnormalities induced by infection.Chills, high fever, cough, chest pain, and disturbance of consciousness are the main clinical manifestations of sepsis.Severe sepsis can lead to organ dysfunction or circulatory disorder, which is life-threatening and is often accompanied by acute lung injury. Its prognosis is poor and it has a high mortality rate.
✦case summary✦
The child, a boy aged 4 years and 3 months, developed fever 10 days before admission. Anti-infective treatment was given to the local hospital, but his body temperature did not improve. He developed joint swelling and pain 4 days before admission.
The child had fever, accompanied by chills and chills, and joint swelling and pain occurred 6 days after the fever.Clinical manifestations include pulmonary infection, osteomyelitis, soft tissue infection, etc., without obvious skin ulceration.
Blood culture, bone marrow culture, and peripheral blood mNGS all showed Burkholderia pseudomallei.
After admission, contact isolation was adopted, the ankle joint was immobilized, and anti-infective treatments such as meropenem, linezolid, doxycycline, compound sulfamethoxazole, and ceftazidime were administered.
After clinical outcome, the body temperature was normal and the joint swelling and pain improved.
Picture of mNGS test report of children
The child was previously healthy and became ill on the same day as his brother. The possibility of infection through close contact cannot be ruled out.The patient's elder brother was only 10 years old. He was hospitalized in a local hospital for treatment and observation after the onset of the disease. Blood culture and peripheral blood mNGS showed Burkholderia pseudomallei. He died of 'septic shock' 3 days later.
It is worth noting that my brother went to play in rice fields more than ten days before he became ill...and rice fields are an excellent habitat for Burkholderia pseudomallei.
Pathogen encyclopedia
Melioidosis is a tropical and subtropical zoonotic disease caused by the bacterium Burkholderia pseudomallei.Burkholderia pseudomallei is a Gram-negative bacillus, and the climate conditions and humidity in tropical and subtropical areas are conducive to the growth and reproduction of this bacterium.This fungus can survive in water sources, soil and some plants. It is especially common in rice fields and has strong environmental adaptability.
Popularity and transmission channels
Melioidosis is prevalent in Southeast Asia and northern Australia. In my country, it is mainly distributed in Hainan, Guangxi, Guangdong, Fujian, Hong Kong and Taiwan.The disease can occur in all age groups, with adults aged 40-60 being the peak population. It is rare in children and has a high mortality rate.Its incidence is positively correlated with rainfall, and it is mostly caused by skin contact with soil or water in rainy season.
Clinical manifestations and diagnostic criteria
The clinical manifestations of melioidosis are diverse and similar to those of other types of diseases, such as sepsis, septic shock, community-acquired pneumonia, tuberculosis infection, etc., so it is often misdiagnosed clinically.The disease has an incubation period of 9 days (range 1-21 days) but can progress rapidly (<24 hours) after inhalation.The diagnosis of melioidosis should be based on epidemiological characteristics, clinical symptoms and laboratory tests.
The gold standard for clinical diagnosis is the culture, isolation and identification of pathogenic bacteria.Acute melioidosis requires rapid recognition by clinicians and early hospitalization.Doctors therefore play an important role in identifying the disease at its earliest stages and stabilizing it at an early stage.
Treatment and drug resistance
The treatment options for melioidosis are mainly divided into intensive and eradication treatments. Sustaining a sufficient amount of sensitive antibiotics during the treatment period can have better therapeutic effects and better prognosis.Burkholderia pseudomallei has natural and acquired resistance, and is highly resistant to a variety of antibiotics such as penicillin, first and second-generation cephalosporins, erythromycin, gentamicin, and streptomycin.Burkholderia pseudomallei is also sensitive to drugs such as meropenem, ceftazidime, compound sulfamethoxazole, and doxycycline.
The incidence and severity of melioidosis are related to host factors, environmental factors and the virulence of the strain. The main risk factors for adult hosts include diabetes, alcoholism, chronic kidney disease and chronic lung disease.The patient and his brother were children who had been in good health and had no relevant risk factors.The child improved after active anti-infective treatment, but the child's brother died 3 days after the onset of illness. Therefore, clinicians should collect blood culture and other specimens as soon as possible and give sensitive antibiotic treatment to improve the prognosis.
references:[1] Li Yuchuan, Xie Xinbao, Wang Jianshe. A case of Burkholderia pseudomallei sepsis in children [J/CD]. Chinese Clinical Case Results Database, 2022, 04(1): E01316-E01316. DOI: 10.3760/cma.j.cmcr. 2022.e01316.