Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India

Area of Science:

• Infectious Diseases
• Bacteriology
• Musculoskeletal Infections

Background:

• Melioidosis is a significant cause of sepsis in Southeast Asia and Australia, often affecting organs like the lungs, liver, and spleen.
• While musculoskeletal melioidosis is rare in India, sporadic cases involving soft tissues have been reported.
• Patients with diabetes, chronic renal failure, and thalassemia are particularly susceptible to severe melioidosis.

Purpose of the Study:

• To report on a series of five patients with musculoskeletal melioidosis encountered over a two-year period in India.
• To highlight the clinical presentation, diagnosis, and treatment outcomes of musculoskeletal melioidosis.
• To emphasize the potential for increased diagnosis of this condition with greater awareness.

Main Methods:

• Retrospective case series analysis of five patients diagnosed with musculoskeletal melioidosis.
• Diagnosis confirmed by positive pus cultures for Burkholderia pseudomallei.
• Treatment involved surgical debridement and a six-month course of combination antibiotics (ceftazidime, amoxicillin-clavulanic acid, co-trimoxazole, doxycycline).

Main Results:

• All five patients presented with multifocal osteomyelitis, recurrent osteomyelitis, or septic arthritis.
• One patient succumbed to septicemia and multi-organ failure.
• The remaining four patients recovered completely with no recurrence after completing antibiotic therapy.

Conclusions:

• Musculoskeletal melioidosis, though uncommon, can present with severe manifestations like osteomyelitis and septic arthritis.
• Prompt diagnosis through pus culture and aggressive treatment with surgical debridement and prolonged antibiotics are vital for favorable outcomes.
• Increased clinical suspicion and improved diagnostic capabilities may lead to more frequent identification of musculoskeletal melioidosis in the future.