Abstract
Melioidosis involving bone, joints, and soft tissue is rare and reported usually following dissemination of disease from infection elsewhere in the body; to a lesser degree, it can also be reported as the primary manifestation of melioidosis. The orthopedic registry at Hospital University Sains Malaysia from 2008 until 2014 was retrospectively reviewed and was followed by molecular typing of Burkholderia pseudomallei. Out of 20 cases identified, 19 patients were confirmed to have osteoarticular and/or soft-tissue melioidosis. The majority of the patients were males (84%), and 16 patients had underlying diabetes mellitus with no significant estimated risk with the disease outcomes. Bacterial genotype was not associated with the disease as a risk. Death was a significant outcome in patients with bacteremic infections (p = 0.044). Patients with lung or skin melioidosis require careful treatment follow-up to minimize the chance for secondary osteoarticular infection. Human risk factors remain the leading predisposing factors for melioidosis. Early laboratory and clinical diagnosis and acute-phase treatment can decrease morbidity and mortality.
Highlights
Melioidosis involving bone, joints, and soft tissue is rare and reported usually following dissemination of disease from infection elsewhere in the body; to a lesser degree, it can be reported as the primary manifestation of melioidosis
All patients diagnosed with melioidosis associated with bone, joint, or soft tissue, either primary or secondary to disseminated B. pseudomallei infection that originated from other organs, were included
Patients’ gender was not associated with a higher risk for soft tissue than bone/joint melioidosis (p = 0.530 versus p = 0.582; risk ratio = 0.38 [95% CI 0.02–5.2])
Summary
Melioidosis involving bone, joints, and soft tissue is rare and reported usually following dissemination of disease from infection elsewhere in the body; to a lesser degree, it can be reported as the primary manifestation of melioidosis. Bacterial genotype was not associated with the disease as a risk. Conclusion: Patients with lung or skin melioidosis require careful treatment follow-up to minimize the chance for secondary osteoarticular infection. Musculoskeletal melioidosis is rare but not uncommon; septic arthritis and osteomyelitis are usually secondary infections that commonly occur following bacterial dissemination from infection elsewhere in the body. The commonest musculoskeletal melioidosis presentations are soft-tissue involvement, followed by osteomyelitis, septic arthritis and, less commonly, spine infection [1]. Molecular techniques have been used for rapid diagnosis of the infection as well as for bacterial genotyping [2]
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