Osteomyelitis and Septic Arthritis Due to Burkholderia pseudomallei: A 10-Year Retrospective Melioidosis Study From South China

Abstract

Burkholderia pseudomallei is the causative agent of melioidosis, endemic mainly in tropical and subtropical areas. Its clinical manifestation is broad ranging from a localized skin lesion to a life-threatening systemic disease. Osteomyelitis and septic arthritis caused by B. pseudomallei are a rare, fatal illness, whose clinical features have not been illustrated in mainland China. Over 10 years (2010 to 2019), of 334 culture-confirmed melioidosis in Hainan province, China, 44 patients (13.2%) were confirmed to have osteomyelitis and septic arthritis through the combination of clinical features, imaging examination and microbiological culture. Herein, we summarized these 44 patients’ clinical manifestations, demographical features, antibiotic treatment, and outcomes. Of them, osteomyelitis and septic arthritis accounted for 25 (56.8%) and 15 (34.1%), respectively, and 4 patients (9.1%) had both. The gender ratio of male/female was approximately 13.7:1; diabetes mellitus was the most common risk factor (38/44, 86.4%); imipenem and trimethoprim/sulfamethoxazole were the most frequently used antibiotics. Most B. pseudomallei strains were isolated from blood samples (41/44, 93.2%). After surgical handling, antibiotic treatment, or both, 9 patients died, with a mortality rate of 20.5%. In summary, in melioidosis endemic areas, for patients with both localized manifestations of joint and bone and a positive B. pseudomallei blood culture, increased awareness is required for melioidotic osteomyelitis and septic arthritis.

Risk Factors for Melioidosis Mortality and Epidemics: A Multicentre, 10-Year Retrospective Cohort Study in Northern Hainan

“…As persistent hyperglycaemia further worsens the condition of melioidosis, the aggravation of melioidosis also leads to poor blood sugar control, forming a vicious cycle [ 17 , 18 ]. Most of the cases in our study also occurred in coastal areas and during the rainy season in summer and fall, which is consistent with the case reports in Hainan, China [ 19 , 20 ]. In our study, we have observed a sharp increasing in the number of cases after 2014, reasons for which may be for the increased awareness of melioidosis, improvement of B. pseudomallei detection technology and higher level of diagnosis of melioidosis.…”

“…In our study, six patients (6.67%) died of illness during hospitalisation, with a mortality rate lower than the 10–40% reported in previous studies [ 5 , 17 , 19 ]. This was related to the increasing awareness of melioidosis and to the poor follow-up after the automatic discharge of some patients with worsened disease in our study due to local cultural customs and economic reasons.…”

Critical approach to atypical spectrum of melioidosis: a case-series based literature review

“…A retrospective study done by Perumal et al 26 showed that out of 342 patients diagnosed with B. pseudomallei , 37 (9.2%) had musculoskeletal involvement. Knee joint is reported to be the most commonly involved joint by melioidosis, as opposed to the shoulder joint involvement in our case 27…”

Chronic Splenic Melioidosis in a Patient with Fever of Unknown Origin Diagnosed by Metagenomics Next-Generation Sequencing: An Emerging Cause and Literature Review

“…Fever is the most common clinical presentation of melioidosis, in 66–95.5% of cases. 7 , 8 Melioidosis caused by B. pseudomallei can cause FUO, and should be included in the differential diagnosis of FUO, especially for patients with FUO who are from endemic regions.…”