Lakdini Fernando¹, Lakmie Edirisooriya¹, Enoka Corea², Sanjaya Abeygunasekara¹, Dhammika Vidanagama¹
1- Lady Ridgeway Hospital for Children, Sri Lanka
2- Faculty of Medicine, University of Colombo, Sri Lanka
Abstract Body
Introduction: Melioidosis is relatively uncommon in children, accounting for 5-15% of the cases.Risk factors like chronic diseases and immunosuppression are seen in only 25%. “The great mimicker’’ has a multitude of presentations, with distinctive regional patterns noted in children. Parotid abscesses are common in Southeast Asia, probably owing to ingestion of unchlorinated water. Neurological presentations and pneumonia predominate in Northern Australia, probablydue to the risk of inhalation during adverse weather.
Case presentation: A one-year-and-five-month-old girl presented to the local hospital withleft-sided neck swelling and fever for four days. She had a history of intermittent fever in the preceding two months. She used to play with soil frequently and was given un-boiled drinking water from a well. A parotid abscess was detected and drained, and the child was discharged after IV coamoxiclav for 7 days. After readmission with the same symptoms, she wastransferred to tertiary care for further management. Imaging showed suppurative cervicallymphadenitis, and the drained pus yielded a growth of Burkholderia pseudomallei. The intensive phase of treatment was completed with 3 weeks of IV meropenem and oral cotrimoxazole.Residual abscesses were excluded, and eradication therapy with oral cotrimoxazole plus folic acid was given for 3 months.
Conclusions: Melioidosis should be among the differential diagnoses in children presentingwith parotid abscess and cervical lymphadenopathy in an endemic country such as Sri Lanka. Adequate surgical management, sending samples for bacterial cultures, and prolonged antibiotic therapy with proper compliance need to be ensured to prevent treatment failures.