Melioidosis of the Musculoskeletal System

Abstract

Objective: Recent studies indicate that India is an endemic region for Burkholderia pseudomallei infection. We aimed to describe the clinical presentation of B. pseudomallei infection of the musculoskeletal system and summarise the various treatment modalities used in our clinical practice. Subjects and Methods: Patients with confirmed microbiological diagnosis of B. pseudomallei infection involving the musculoskeletal system treated from January 2007 to December 2016 with a minimum follow-up of 1 year were included. A retrospective review of medical records was carried out and patients’ demographic data, co-morbidities, clinical presentation, and details of medical and surgical treatment were documented. Results: Of 342 patients diagnosed with B. pseudomallei infection, 37 (9.2%) had musculoskeletal involvement; 26 patients (23 males) followed up for at least a year were included in the study. Four patients (15%) had multisystem involvement and 10 (37%) had multiple musculoskeletal foci of infection; 15 patients (58%) had osteomyelitis, 10 (38%) had septic arthritis with or without osteomyelitis, and 1 patient (4%) presented with only soft tissue abscess. All patients required surgical intervention in addition to medical management. Surgical treatment varied from soft tissue abscess drainage, arthrotomy for septic arthritis, decompression and curettage for osteomyelitis, and/or use of antibiotic (meropenem or ceftazidime)-loaded polymethylmethacrylate bone cement for local drug delivery. At final follow-up (average: 37 months, range: 12–120), all patients were disease free. Conclusion: We found the rate of musculoskeletal involvement in B. pseudomallei infection to be 9.2%. Appropriate surgical treatment in addition to medical management resulted in resolution of disease in all our patients.

Identification and Characterization of Burkholderia pseudomallei from Localized Pyogenic Infections in Eastern India: A Clinico-Microbiological Study

“…As regards musculoskeletal involvement, of 26 patients from South India with musculoskeletal melioidosis, 15 (58%) had osteomyelitis, 10 (38%) had septic arthritis, and one (4%) had soft tissue abscess. 38 From outside India, localized melioidosis as the predominant manifestation was seen in a study from Thailand in which, of 134 patients from January 2002 to June 2011, the majority cases (62.7%) were localized unifocal or multifocal infection without bacteremia. 10 A study from Bangladesh over a prolonged period from 1961 to 2017 noted musculoskeletal (21, 43%), organ abscess/deep-seated abscess (13, 27%), and cutaneous (13, 27%) lesions to be the predominant manifestations.…”

“…3,9,27 Overall, an excellent outcome was observed similar to other studies of localized cutaneous or musculoskeletal infections, where a high rate of resolution has been seen. 38,42 Susceptibility studies from India and elsewhere reveal that antimicrobial resistance in B. pseudomallei has been extremely low to most of the antibiotics, except amoxicillinclavulanic acid and trimethoprim-sulfamethoxazole. 32,43 A study of more than 4,000 B. pseudomallei isolates in Thailand and more than 600 isolates in Singapore reported ceftazidime resistance at 0.5%, whereas multiple smaller studies demonstrated 100% susceptibility.…”

Melioidosis Manifesting as Chronic Femoral Osteomyelitis in Patient from Ghana

“…Approximately 7.6%–14.4% of melioidosis cases have musculoskeletal involvement ( 13 – 15 ). A longer duration of infection appears to increase the risk for bone and joint involvement.…”

Pyomyositis masquerading as suprapubic mass: An unusual presentation of melioidosis

“…Melioidosis, an infection caused by the Gramnegative bacterium Burkholderia pseudomallei is associated with a broad spectrum of clinical manifestations involving different organ systems [1]. Musculoskeletal melioidosis is an uncommon but well-recognized manifestation of the disease [2,3]. Here, we report a case of pyomyositis with abscesses in the obturator externus and adductor muscles.…”