Musculoskeletal Melioidosis Research Articles

Musculoskeletal melioidosis- a retrospective review of 22 cases from a tertiary care centre in South Tamilnadu

A retrospective review of culture confirmed musculoskeletal melioidosis reported between December 2014 and February 2024 was conducted. 22 of 100 patients with culture proven melioidosis infection had musculoskeletal involvement. Median age was 47 years with 95.4% being males. Osteomyelitis, septic arthritis and septic arthritis along with adjacent osteomyelitis were observed in 12, 9 and 4 cases respectively. All isolates were susceptible to meropenem and susceptible increased exposure to ceftazidime, doxycycline and cotrimoxazole. Twelve patients underwent surgical procedures. Four patients who died due to septicemia had multisystem involvement with positive blood cultures.

Musculoskeletal melioidosis in a 33-year-old farmer presenting with the right leg cellulitis: A case report from North India

Melioidosis, caused by Burkholderia pseudomallei, has been described as “the great mimicker” due to its varied clinical presentation. Musculoskeletal melioidosis is a rare presentation of this disease, and here we report a 33-year-old male, farmer from Madhya Pradesh, who presented with fever for 2 months and right leg swelling for 25 days. He was treated elsewhere as cellulitis and managed with intravenous antibiotics and fasciotomy. Magnetic resonance imaging knee and leg showed diffuse osteomyelitis of the upper tibia with similar tiny foci and sinus tract present. A diagnosis of the right knee septic arthritis with multifocal osteomyelitis was made. Focal pus culture grew pansensitive B. pseudomallei. He was started on Inj. Meropenem and oral cotrimoxazole tablet. He also underwent right tibial debridement, sequestrectomy, and saucerisation. He was discharged after initial therapy and has improved significantly on follow-up. This case highlights a very common clinical condition caused by a rather uncommon etiological agent and therefore renumerates the importance of insightful clinical suspicion with appropriate use of investigations and treatment options to prevent further morbidity and mortality.

A case report of melioidosis complicated by infective sacroiliitis in Sri Lanka

BackgroundMelioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei. It can present as septicemia, localized infection with/without septicemia, asymptomatic infections, ulcers, pneumonia, visceral abscesses, neurological infection, musculoskeletal infections and can involve any organ.Case presentationA 56 year old Sri Lankan diabetic female presented with fever, chills and rigors for 2 weeks. She also had malaise and loss of appetite, but no other features. On examination, she was febrile (temperature was 101.4 0 F) and rest of the examination was unremarkable. Her blood culture was positive for Burkholderia pseudomallei and she was started on IV antibiotics, on day 3. During her 2nd week of hospital stay, she developed right sided low back pain with buttock pain, right hip joint pain and restricted hip joint movements suggestive of right sacroiliitis. CE CT and MRI scans confirmed the diagnosis of right iliopsoas abscesses and right sacroiliitis.Incision and drainage was performed and a pigtail catheter was left in place for continuous drainage of abscesses. Her intensive phase was initiated with IV ceftazidime 2 g every 6 h for 12 days, then changed over to IV meropenem 2 g every 8 h together with oral co-trimoxazole. 2 weeks later, oral co-trimoxazole was replaced by oral doxycycline for another 6 weeks (due to transient pancytopaenia). She made a complete and uneventful recovery with oral co-trimoxazole for another 6 months, in her eradication phase.We report this case to show the importance in early diagnosis of melioidosis, and to consider it in the differential diagnosis of multiple abscesses and to emphasize the importance in suspecting melioidosis as a causative agent in infective sacroiliitis.DiscussionMelioidosis can have 2 major presentations; acute infection (symptoms lasting less than 2 months) and chronic infection (symptoms lasting more than 2 months). Musculoskeletal melioidosis is a well-recognized manifestation of the disease, which can manifest as soft tissue abscesses, septic arthritis, spondylitis, sacroiliitis and osteomyelitis.Management of melioidosis consists of 2 phases. The intensive phase and the eradication phase. These are aimed at the importance of rapidly treating the septicemia, the need of eradication of the persistent disease and the prevention of recurrent infections or relapses. The intensive phase consists of minimum 10–14 days of IV antibiotics: IV ceftazidime or IV carbapenem (meropenem/ imipenem). Eradication phase should be followed by 3–6 months of oral co-trimoxazole alone or in combination with oral doxycycline/ oral amoxiciliin-clavulanic acid.

Clinical and Imaging Findings of Musculoskeletal Melioidosis in the Right Hip: A Case Report

Clinical and Imaging Findings of Musculoskeletal Melioidosis in the Right Hip: A Case Report

Clinical Outcomes in Musculoskeletal Involvement of Burkholderia Pseudomallei Infection.

BackgroundMusculoskeletal involvement in melioidosis is often seen in conjunction with a disseminated illness. Recent reports suggest that operative management of musculoskeletal melioidosis has favourable results. The purpose of this study was to review the patient profile and clinical outcomes of Burkholderia pseudomallei infection in the musculoskeletal system.MethodsHospital records of 163 patients who were diagnosed to have B. pseudomallei infection between January 2009 and December 2014 were reviewed. Patients underwent surgical and nonsurgical management depending upon the tissue of involvement. Epidata software was used to record the data. The SPSS ver. 17.0 was used for analysis.ResultsEighteen out of 24 patients who had musculoskeletal melioidosis were available for follow-up. Septic arthritis, osteomyelitis, and intramuscular abscess were the common diagnosis, with 6 patients in each group. Twelve patients required surgical intervention. All patients received a full course of parenteral ceftazidime followed by oral doxycycline and co-trimoxazole. Two out of 6 patients (33.3%) died among those who had nonsurgical management as compared to none in the group who had surgical management. This was significant at 10% level of significance (p = 0.098). The rest were followed up for a minimum of 1 year with no evidence of disease recurrence.ConclusionsThis series describing musculoskeletal involvement in melioidosis is the largest such study from a recently recognized ‘endemic’ region. Of importance are the patterns of musculoskeletal involvement, pitfalls in diagnosis and adequate clinical response with timely diagnosis and appropriate surgical management.

Musculoskeletal melioidosis: An under-diagnosed entity in developing countries

BackgroundMelioidosis is a saprophytic infectious disease caused by Gram-negative soil-dwelling bacillus Burkholderia pseudomallei. Materials & methodsWe report three cases of musculoskeletal melioidosis that are presented to our department from 2011 to 2013. ResultsOne of the patients died due to post-septicemic ARDS. The other two patients have recovered fully and are followed up for minimum of 6 months. There were no recurrences. ConclusionsThough musculoskeletal infection due to melioidosis is not common in India, new cases are being reported from Karnataka, Goa and Southern Maharashtra. The need for diagnosing this entity is due to the fact that the septicemic form has a mortality rate that exceeds 90%, and though culture sensitivity report shows susceptibility to various antibiotics, the infection responds to only specific set of antibiotics i.e. intravenous ceftazidime and combination of trimethoprim and sulfamethoxazole.

Musculoskeletal Melioidosis

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.

Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India

Melioidosis, an infection due to gram negative Burkholderia pseudomallei, is an important cause of sepsis in east Asia especially Thailand and northern Australia. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids especially in patients with diabetes, chronic renal failure and thalassemia. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. During a two-year-period, we had five patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis. One patient died early because of septicemia and multi-organ failure. All patients were diagnosed on the basis of positive pus culture. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia. All other patients recovered completely with no recurrences. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.

Osteomyelitis of Parietal Bone in Melioidosis

Osteomyelitis of Parietal Bone in Melioidosis

Melioidosis: A review of orthopedic manifestations, clinical features, diagnosis and management

Melioidosis is an infectious disease caused by gram-negative soil-dwelling bacillus Burkholderia pseudomallei. Musculoskeletal melioidosis mimics other infections both clinically and radiologically. An extensive literature review has been performed over musculoskeletal melioidosis through various search engines such as Pubmed, Embase, Medscape, Altavista and Google. Diagnosis requires a high index of clinical suspicion and is dependent on microbiological confirmation. Prompt treatment with long-term combination antibiotics in high dosages and surgical drainage of abscesses improves survival.

Musculoskeletal melioidosis: clinical and imaging features

Melioidosis is a tropical infection caused by a gram-negative bacillus, Pseudomonas pseudomallei. The disease manifests initially as localized suppurative lesions and can progress to acute disseminated septicemia with 65-90% mortality if inadequately treated. Musculoskeletal involvement is common. The purpose of this study was to describe the clinical features and imaging appearances of musculoskeletal melioidosis. We retrospectively analyzed the clinical profiles and images of 26 patients diagnosed over a 6-year period as suffering from melioidosis. The study group comprised 11 patients with musculoskeletal melioidosis and 15 patients with nonmusculoskeletal melioidosis. We found that musculoskeletal melioidosis mimicks other infections both clinically and radiologically. Clinical awareness is therefore crucial, as diagnosis can only be established by bacteriological and immunological studies. Prompt treatment with long-term combination antibiotics in high dosages and surgical drainage of abscesses improves survival.