Rapid diagnosis of skin and soft tissue melioidosis in children

Melioidosis is an endemic infection caused by Burkholderia pseudomallei, found in tropical and subtropical regions. In resource-limited settings, culture-based diagnostics are often slow, delaying appropriate treatment, or unavailable. We conducted an interventional ambispective cohort study to assess the impact and diagnostic accuracy of the Active Melioidosis Detect Plus rapid diagnostic test (AMD-RDT) in Cambodian children with suspected skin and soft tissue melioidosis (SST-M). The retrospective cohort (July 2022-July 2023) received standard diagnostics; the prospective cohort (July 2023-December 2024) included AMD-RDT testing. Twenty-five retrospective culture-confirmed participants and 107 participants (31 culture-confirmed) in the prospective arm were analysed. Median time from pus collection to appropriate antibiotic initiation was 118.4 hours in the retrospective arm and 14.4 hours in the prospective arm (p = 0.057). Disseminated melioidosis workups were completed for 24% (6/25) and 80.6% (25/31) of retrospective and prospective participants respectively (p < 0.001), and detected two children with bacteraemia and three with intra-abdominal abscesses in the prospective arm. The AMD-RDT achieved a sensitivity of 90.3% (95% CI: 74.2-98.0%), specificity of 100% (95% CI: 95.3-100%), and an area under the receiver operating characteristic curve (AUC) of 0.95 (95% CI 0.89-1.00). Incorporating the AMD-RDT into the routine diagnostic pathway was associated with a reduction in time to effective antibiotic therapy and an increase in the proportion of participants completing a comprehensive diagnostic workup for systemic involvement. The high accuracy and rapid turnaround time support its use in resource-limited settings.