Musculoskeletal Melioidosis

Abstract

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed.

Melioidosis associated with chronic osteomyelitis and visceral organ abscesses

“…Risk factors include diabetes, kidney disease and heavy alcohol consumption. Musculoskeletal infection, including septic arthritis, osteomyelitis, pyomyositis and soft tissue abscesses, is usually seen as a part of multi organ involvement (2). The imaging features of melioidosis in long bones include soft tissue swelling, increased…”

Talus osteomyelitis: An uncommon manifestation of melioidosis

“…Imaging findings are nonspecific but can include septic arthritis (e.g. joint effusion on MRI), osteomyelitis (bony destruction on radiographs and MRI), pyomyositis, or soft tissue abscesses (Pattamapaspong and Muttarak, 2011). Multisystem involvement, particularly if accompanied by a predisposing disease, is an important clue to the diagnosis (Muttarak et al, 2009).…”

Neck Mass in a Returning Traveler

“…Clinical manifestations range from indolent, chronic infections to fulminant sepsis. 1 Mortality due to disseminated melioidosis reaches 50% in some regions. 2 Melioidosis typically causes abscesses in the lungs, skeletal muscle, and visceral organs but rarely in soft tissue.…”