Pediatric melioidosis: a scoping review of epidemiology, clinical presentation, management, and outcomes

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.