Objective: To study the clinical characteristics of melioidosis in southern Thai children.

Design: Retrospective, descriptive hospital-based study of medical records.

Materials and methods: A retrospective review of medical records of children admitted to Hatyai Hospital between 1985 and 1998 in whom Burkholderia pseudomallei was isolated from clinical specimens.

Results: We found 59 cases of pediatric melioidosis occurring in all age groups (age range = 3 days - 14 years) with peak prevalence during the rainy season. All except one of the patients resided in rural areas. Twenty-two patients (37%) presented with the septicemic form. This group was younger (8 were neonates) and had high fever with lung infection (73%) together with multiorgan involvement (68%), with diarrhea (45%) or peritonitis (18%). Thirty-seven patients presented with localized infection, most commonly with parotid abscess (30%) or cervical lymphadenitis (29%). Only six (10%) patients had underlying diseases, all of whom had septicemic melioidosis. None of the patients with localized melioidosis were immunocompromised and none died. However, case fatality was 81% among patients with septicemic melioidosis and 100% among the 8 patients with neonatal melioidosis. Only 2 patients with septicemic melioidosis were suspected of having melioidosis and only 4 received appropriate antibiotics.

Conclusion: Melioidosis is an endemic disease associated with considerable mortality in southern Thailand, especially among children with septicemic form, and therefore clinicians should include melioidosis in the differential diagnosis of children who present with pneumonia together with diarrhea and multiorgan involvement or in children with subacute parotid abscess or cervical lymphadenitis.