Clinical Spectrum and Organ Involvement in Pediatric Melioidosis: A Systematic Review and Meta-Analysis.

Background: Pediatric melioidosis causes substantial morbidity and mortality in tropical regions, yet its clinical spectrum has not been comprehensively quantified. We conducted a systematic review and meta-analysis to characterize clinical manifestations, organ involvement, and mortality among children with melioidosis. Methods: PubMed, Embase, and Scopus were searched from inception to 31 May 2026 for observational studies reporting clinical manifestations or outcomes in children (<18 years) with melioidosis. Pooled prevalence estimates and case-fatality rates were calculated using random-effects generalized linear mixed models with logit transformation. Heterogeneity was assessed using Cochran's Q, I2, and τ2. Country subgroup analyses were performed, and small-study effects were assessed for outcomes with at least ten studies. Results: Twenty-five studies involving 6874 children from 10 countries were included. Localized infection predominated (69%; 95% CI, 52-82%), whereas disseminated infection occurred in 30% (95% CI, 18-46%). Skin and soft tissue infection was the most frequent manifestation (31%; 95% CI, 23-41%), followed by lymphadenitis (24%; 95% CI, 3-76%), pneumonia (18%; 95% CI, 17-19%), and parotitis (13%; 95% CI, 5-28%). Bacteremia occurred in 23% (95% CI, 11-43%), septic shock in 6% (95% CI, 0-53%), and the pooled case-fatality rate was 12% (95% CI, 7-20%). Significant geographic variation was observed for localized infection, disseminated infection, pneumonia, bacteremia, and mortality (all p < 0.01). Small-study effects were detected for several outcomes. Conclusions: Pediatric melioidosis predominantly presents as localized disease, but disseminated infection, bacteremia, and mortality remain clinically important. Geographic variation and substantial heterogeneity highlight differences in disease presentation across settings. These findings provide quantitative evidence to support earlier recognition, diagnostic evaluation, and timely management of pediatric melioidosis in endemic regions.