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Melioidotic septic arthritis: a case report and literature review
1Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. khinger10@yahoo.com.sg
Abstract:
Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in southeast Asia and northern Australia. In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare but well-recognized manifestation of melioidosis. Patients with underlying medical conditions, such as diabetes mellitus, renal impairment, cirrhosis, and malignancy are at greater risk. The presentations of melioidotic septic arthritis often mimic other disease processes and patients may not always be clinically septic. We present a case of septic arthritis due to B. pseudomallei in a 66-year-old male with diabetes mellitus presenting with a history of fever and ankle swelling. Follow-up ankle X-ray showed soft tissue swelling. Synovial fluid and blood samples grew B. pseudomallei. The patient improved gradually after parenteral administration of ceftazidime (2 g 8-hourly) and cotrimoxazole (1440 mg 8-hourly). He was discharged on oral cotrimoxazole (1440 mg 12-hourly), doxycycline (100 mg 12-hourly), and chloramphenicol (500 mg 6-hourly) for 6 months. This case highlights the possible occurrence of melioidotic septic arthritis, and the importance of prompt initiation of appropriate antimicrobials to achieve good outcomes.
Insights
Melioidosis, caused by Burkholderia pseudomallei, can lead to septic arthritis, especially in individuals with diabetes. Early antibiotic treatment is crucial for favorable outcomes in this rare but serious condition.
Area of Science:
- Infectious Diseases
- Rheumatology
- Microbiology
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is increasingly recognized globally.
- Septic arthritis is a rare but significant manifestation of melioidosis.
- Patients with comorbidities like diabetes mellitus are at higher risk.
Observation:
- A 66-year-old male with diabetes presented with fever and ankle swelling.
- Clinical presentation mimicked other conditions, and the patient was not overtly septic.
- Radiography revealed soft tissue swelling, and synovial fluid/blood cultures confirmed B. pseudomallei.
Findings:
- The case demonstrates a rare presentation of melioidotic septic arthritis.
- Successful treatment involved parenteral ceftazidime and cotrimoxazole, followed by a 6-month oral regimen.
- Prompt antimicrobial therapy led to gradual patient improvement.
Implications:
- Highlights the importance of considering melioidosis in septic arthritis, particularly in endemic areas or with relevant risk factors.
- Emphasizes the need for prompt diagnosis and appropriate antimicrobial selection for effective management.
- Underscores the potential for good outcomes with timely and correct treatment of melioidotic septic arthritis.
