Aug 2026· Indian Journal of Medical Microbiology· pp.
101274
· 0 citations· 27 references
Medicine
TL;DR
Pediatric melioidosis follows a phenotype-severity continuum, with outcomes strongly influenced by disease pattern and timeliness of diagnosis, and key priorities for clinical practice and future research are highlighted.
Abstract
Background
Pediatric melioidosis is an under-recognised but potentially severe infection caused by Burkholderia pseudomallei. Evidence is largely fragmented across case reports and small series, limiting understanding of disease patterns, severity, and outcomes in children.
Methods
A scoping review was conducted in accordance with PRISMA-ScR 2020 guidelines. PubMed and Google Scholar were searched up to December 2025 for studies reporting culture-confirmed melioidosis in children (≤18 years). Case reports, case series, and observational studies were included. Given the heterogeneity of available data, findings were synthesised narratively with emphasis on clinical patterns and outcome determinants.
Results
A total of 140 studies comprising 1,058 pediatric cases were included. Most cases were reported after 2000 and originated from Southeast Asia and northern Australia. Pediatric melioidosis demonstrated a broad clinical spectrum, ranging from localized infections (predominantly parotid, lymphatic, and skin involvement) to severe disseminated disease with bacteraemia and pneumonia. Overall mortality was 22.4% (229/1024). Mortality was markedly lower in localized melioidosis (0.7%; 4/557) than in disseminated disease (46.2%; 226/489) and was highest in neonatal (56.0%) and neurologic melioidosis (51.7%). Diagnostic delay ranged from 1 to 420 days and was frequently associated with severe and fatal outcomes, suggesting progression from initially localized infection to disseminated disease.
Conclusions
Pediatric melioidosis follows a phenotype-severity continuum, with outcomes strongly influenced by disease pattern and timeliness of diagnosis. Early recognition of localized disease and prompt microbiological confirmation are critical to preventing progression and reducing mortality. This review provides a consolidated framework for understanding pediatric melioidosis and highlights key priorities for clinical practice and future research.
BACKGROUND
Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum and is increasingly recognised in India, but its epidemiology, clinical spectrum, diagnosis, treatment, and outcomes remain poorly characterised. We conducted a systematic review of reported cases from India.
METHODS
A PROSPERO-registered review (CRD42024556630) was conducted using PubMed, Embase, and Web of Science for studies published up to February 2025, without language restrictions. Two reviewers independently screened records and extracted individual patient-level data. Organ involvement was defined a priori using site-specific histopathological, cytological, microbiological, or molecular confirmation, with compatible clinico-radiological involvement accepted in confirmed cases. Descriptive and exploratory individual-level comparative analyses were performed.
RESULTS
We included 320 studies contributing 508 unique cases. Reporting increased markedly after 2015. Cases were geographically widespread, with the highest numbers from Delhi (16.9%), West Bengal (13.8%), Punjab (12.0%), Haryana (9.4%), Maharashtra (8.3%), Uttar Pradesh (7.7%), and Rajasthan (7.1%). The mean age was 47.6 years (SD 16.5), and 403/493 (81.7%) were male. Immunosuppression was documented in 188/508 (37.0%), most commonly HIV infection and diabetes mellitus. Disease was frequently extrapulmonary and multisystemic, with cutaneous (31.5%), adrenal (29.9%), lymph node (29.8%), hepatic (26.0%), and splenic (25.6%) involvement most common. Pulmonary disease occurred in 15.2% and central nervous system disease in 1.6%. Diagnosis relied predominantly on microscopy, histopathology, or cytology (98.6%); culture (28.0%), antigen detection (4.3%), and PCR (3.0%) were infrequently used. Amphotericin B was used in 262/388 (67.5%) cases with available data, and itraconazole in 306/390 (78.5%). Outcome data were available for 425 patients, of whom 62/425 (14.6%) died.
CONCLUSIONS
Reported histoplasmosis in India is geographically widespread and clinically heterogeneous, with prominent extrapulmonary and disseminated disease. These findings reflect published case patterns rather than true epidemiology, given selective reporting of severe, unusual, or biopsy-confirmed disease. Limited use of culture, antigen detection, and molecular diagnostics highlights important diagnostic gaps. Improved awareness, access to non-culture-based diagnostics, and prospective multicentre studies are needed to define the full clinical spectrum and burden of histoplasmosis in India.
Pediatric Clostridium septicum infections are extremely rare but often fulminant and rapidly progressive. They may manifest as clostridial myonecrosis, sepsis, or with gastrointestinal involvement. Systematic data on presentation, management, and outcomes remain scarce. To systematically review published pediatric cases of C. septicum infection, focusing on clinical presentation, underlying conditions, management, and outcome as an update to the review by Smith-Slatas et al. (2006). In particular, to assess how frequently gastrointestinal involvement occurs in this disease and whether its presence is associated with poorer outcomes. Furthermore, to highlight the diagnostic challenges and therapeutic urgency of this condition through a fatal case. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for reports from May 2006 to May 2025. Studies describing patients under 18 years with confirmed C. septicum infection were included. Variables included infection site, underlying disease, treatment, and outcome. A previously unpublished fatal case of pediatric clostridial myonecrosis with ileocolic intussusception was added. Fisher’s exact test was used for statistical analysis. Only 18 pediatric cases published since 2006 were found; 44% had clostridial myonecrosis and 50% gastrointestinal involvement. STEC-HUS occurred in 50%. Compared with a 2006 review, rates of STEC-HUS, surgical intervention, overall survival, and absence of gastrointestinal involvement have increased. Surgical debridement was strongly associated with survival (p < 0.01), whereas gastrointestinal involvement was associated with fatal outcome (p = 0.014). The reported child deteriorated rapidly after initial intussusception diagnosis and died despite maximal intensive care. Very few cases are available because the disease is exceptionally rare; the analysis is retrospective. Surgical source control is associated with improved survival. Gastrointestinal involvement is a major risk factor for poor outcome and may include intussusception.
Frederike Bieling, Jasmin Özcan, Julius Sommer et al.· BMC Pediatrics· 0 citations
Abstract Introduction Nocardiosis is a bacterial infection predominantly seen in immunocompromised hosts, with patients mainly presenting with pulmonary involvement. Intracranial involvement is rare and is thought to be associated with high mortality. Aim This study aims to evaluate the imaging appearance of intracranial nocardiosis and to assess clinical outcomes. Setting and Design In this retrospective study, 21 patients with intracranial nocardiosis were identified between 2009 and 2023 in a single tertiary care hospital in South India. The patient charts and imaging were assessed, and various radiological findings were documented. Clinical and imaging follow-up was also assessed. Results Four patterns of involvement were seen: large abscesses, smaller abscesses, ring-enhancing lesions, and meningitis. Clinical and radiological discordance was observed, with the Glasgow Coma Scale being normal in the majority of patients despite intracranial abscesses. The presence of lung involvement was common. Mortality was 9.5%, which is low compared to the literature, with good clinical outcomes on follow-up. Conclusion Mortality with intracranial nocardiosis was found to be lower than reported in literature. Pulmonary disease, in the presence of intracranial abscess and immunocompromised status, should raise concerns about nocardial infection.
H. Vanjare, Paul Deepak, B. T. Selvi et al.· Indian Journal of Radiology...· 0 citations
Scedosporium is an emerging opportunistic filamentous fungus widely distributed in soil and stagnant water. Mortality remains substantial and management is often challenging due to intrinsic antifungal resistance and delays in diagnosis. In this retrospective cohort study, we describe the clinical spectrum, microbiological characteristics, and outcomes of microbiologically culture-confirmed scedosporiosis at a tertiary care center in South India between May 2016 and August 2024. Eighteen patients were included, with a median age of 54 years and a predominance of male patients. Contrary to the patterns described in many Western and transplant-focused cohorts, the majority of infections in our series involved osteomyelitis and paranasal sinus disease. Disseminated infection was rare but was associated with poor outcomes. Voriconazole-based therapy was the most commonly used antifungal regimen, and surgical intervention was required in six cases. Our findings highlight a distinct clinical pattern of scedosporiosis in our setting, with osteomyelitis and sinusitis emerging as predominant presentations. These observations emphasize the importance of maintaining a high index of suspicion for Scedosporium infection in chronic bone and sinus disease, particularly when patients fail to respond to conventional antibacterial therapy.
Malavika Krishnakumar, G. Mohan, Apeksha Singh et al.· Medical Mycology· 0 citations
Melioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei - a Tier 1 Select Biological agent - remains a significant cause of severe community-acquired infection in tropical regions, but with recent expanding recognition in temperate climates, including the United States. Pulmonary involvement is the most frequent clinical manifestation, ranging from subclinical nodules to fulminant necrotizing pneumonia and acute respiratory distress syndrome. Despite its clinical severity, melioidosis remains underdiagnosed due to its radiologic mimicry of tuberculosis, broad clinical manifestations, and limited laboratory capacity in many endemic areas. Special Operations Forces (SOF) participating in field exercises or operations in B. pseudomallei endemic countries are at significantly increased risk of infection. Accordingly, SOF medical providers should maintain a high index of suspicion for melioidosis and be familiar with its clinical recognition, diagnosis, and management.
Chase Goldberg, Akira A. Shishido· Journal of special operation...· 0 citations
OBJECTIVES
Following the first pediatric review on Legionnaires' Disease (LD) in 2006, we provide an updated literature review on LD in a pediatric population.
METHODS
We reviewed PubMed and Scopus for case reports and case series of LD in children, extracted clinical-epidemiological data and used the CARE checklist to assess completeness of reporting.
RESULTS
We report a severe case of LD in a previously healthy 15-month-old girl who developed the infection following short-term steroid therapy. The disease was likely acquired in a healthcare setting, despite the implementation of standard water-safety prevention strategies. To contextualize this finding, we systematically reviewed the available literature, identifying a total of 44 pediatric LD cases, predominantly from Europe, Asia, and North America. Sixty-four percent (n=28/44) were up to one year of age, with neonates accounting for one-third of cases (34%, n=15/44). Comorbidities and immune deficiencies were present in 61% (n=27/44) and 41% (n=18/44) of cases, respectively. Hospital-acquired cases were common (55%, n=18/33). Diagnosis relied on PCR (93% positivity, n=26/28) and culture (57%, n=25/44) performed mainly on respiratory samples. Targeted antibiotic therapy was strongly associated with reduced mortality (p=0.031). The overall mortality rate was 23% (n=10/44).
CONCLUSION
Our findings appear consistent with previous observations suggesting a potential benefit of early identification of LD and timely targeted treatment. The high proportion of healthcare-associated LD cases stresses the need for strengthened prevention and infection-control strategies.
Valeria Garbo, Laura Venuti, G. Natoli et al.· International Journal of Inf...· 0 citations