# Rapid diagnosis of skin and soft tissue melioidosis in children

## TL;DR

A rapid diagnostic test for melioidosis in children significantly reduces treatment delay and improves diagnostic accuracy in resource-limited areas.

## Contribution

The study evaluates the impact of a rapid diagnostic test for melioidosis in children, demonstrating faster treatment and higher diagnostic accuracy.

## Key findings

- The AMD-RDT reduced median time to appropriate antibiotic initiation from 118.4 to 14.4 hours.
- The test achieved 90.3% sensitivity and 100% specificity compared to culture-based diagnostics.
- More children in the prospective group completed a comprehensive diagnostic workup for systemic infection.

## Abstract

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.

Melioidosis is a serious infection caused by the soil-dwelling bacterium Burkholderia pseudomallei. Diagnosis requires culture of specimens taken from infected sites, which is the gold standard, but is often slow or unavailable in resource-limited settings. In our study, the Active Melioidosis Detect Plus rapid test was added into routine diagnostic processes. We found children received appropriate treatment faster, with the majority undergoing further testing to look for systemic infection. We also found that the rapid test had excellent accuracy when compared to culture.