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Compassionate healthcare and purposeful innovation for Cambodia’s children

Melioidosis: The Emerging Tropical Disease

Antibiotic Stewardship, COMRU, Laboratory, Sepsis

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Ary was only two years old when she was admitted to AHC with a serious tropical disease infection, burkholderia pseudomallei melioidosis. It took three months – and the collaboration of multiple hospital units working together daily – to successfully treat this emerging and often misunderstood disease.

Melioidosis is a growing tropical disease in Southeast Asia, with manifestations including pneumonia, septicaemia, and localised infection in various organs. Often contracted from contaminated soil and water during the rainy season, melioidosis poses a serious risk to Cambodian children because of the difficulty diagnosing the infection without specialist healthcare.

According to one study, melioidosis mortality can exceed 40% in some low-resource regions. Even when diagnosed correctly, melioidosis infections can still have a high mortality rate in Southeast Asia because it requires microbiology laboratory diagnosis and a long course of antibiotic treatment, which can be costly and often inaccessible to families from poor rural areas.

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Children in rural Cambodia are vulnerable to melioidosis infection during the rainy months, May to October.

Ary had not had any major health issues until her mother noticed Ary had a high fever and took her to a private clinic in their hometown, Damdek commune, Sotr Nikum district. For five days, Ary received antibiotic treatment at the clinic and then a further 12 days of treatment at Sotr Nikom Referral Hospital. However, her condition only worsened; her body was weakening, and her blood count was dangerously low.

Ary’s mother is a construction worker living with her parents and her other five-year-old daughter in a small rural village. The family rely on her income alone, without any support from Ary’s father to help pay expenses. She explains the distress her daughters health issues have caused, adding to the financial insecurity her family are already burdened with. Like many Cambodian families, they face an uncertain future during the COVID-19 pandemic as work becomes harder to find and families are forced further into poverty.

Cases like Ary’s are worryingly common, as the AHC microbiology lab detects 30-60 melioidosis cases each year. “We know the entire medical team needs to be on the same page when treating melioidosis,” says Dr Miliya Thyl, clinical microbiologist at AHC, “otherwise teams can become weary and alter the treatment plan before the infection is fully treated, which is one reason why there is such a high mortality rate in the region.” 

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Dr Miliya Thyl discussing case details with AHC doctors, nurses and students.

Another barrier medical staff encounter when treating melioidosis infections is gaining the cooperation from caregivers to stay in hospital for the full course of treatment. Leaving prior to full treatment can lead to potential readmission of the child and long-term complications. Dr Thyl recalled many caregivers of children with infections leaving the hospital prematurely after seeing improvement in their children’s condition, only for the child’s symptoms to return shortly after returning home. 

“For parents to commit to staying months in hospital, away from their families and not earning an income, can often be a difficult sell. So we need to make sure they fully understand their child’s illness and can see for themselves the risks that stopping treatment poses to their child’s life.”

Dr Miliya Thyl

On the 17th day of her treatment, Ary was transferred to AHC for intensive care treatment. Upon arrival, blood samples were sent to the AHC microbiology laboratory to understand the extent of her illness. After several weeks in medical care and numerous courses of antibiotics at other institutions, effective testing at AHC allowed Ary to finally begin proper treatment for her serious melioidosis infection.

AHC’s microbiologist recommended a course of ceftazidime, a common antibiotic used to treat melioidosis. It took one month of ceftazidime treatment for Ary to show any signs of improvement, and a further three months of oral antibiotic to recover fully, including multiple surgical interventions to remove the source of her infection. Now, Ary has finally returned home, coming back to the hospital for follow-up treatment to revaluate her progress, while taking additional medication at home. 

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Ary and her mother ready to be discharged from AHC, after over three months at the hospital.

Ary’s mother stayed the entire three months in AHC’s Inpatient Department with her daughter. During their stay they receiving financial support from AHC’s Social Work unit to enable her to get the full course of treatment at AHC. “I appreciated the financial help,” says Ary’s mother on the final day before Ary was discharged, “it meant I could take care of my daughter every day during these last three months.” 

Melioidosis cases, like Ary, are yet another reminder to the AHC team about the importance of collaboration between medical professionals, hospital departments, and caregivers as well as the need for specialized and knowledgeable infection testing. AHC will continue to research melioidosis and spread findings amongst healthcare professionals in Cambodia so to improve treatment of this serious tropical disease.

The AHC microbiology laboratory team have been researching melioidosis for the past decade to gain knowledge of the under-recognised and under-diagnosed infection. The team, in collaboration with the University of Oxford’s tropical disease network, COMRU, have published numerous peer-reviewed articles, including investigating the climatic drivers of melioidosis in Laos and Cambodia and the cost-effectiveness of the use of selective media for the diagnosis of melioidosis in different settings. For a full list of published articles click here.

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