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Isolated articular melioidosis
S Saengnipanthkul1, W Laupattarakasem, W Kowsuwon
1Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Thailand.
Abstract:
Melioidosis is an infection caused by a gram-negative bacilli, Pseudomonas pseudomallei. This organism can cause fatal infection in domestic animals and are probably transmitted to humans by soil contamination of skin abrasions, ingestion, and inhalation. Melioidosis is being increasingly diagnosed in Western countries in other than its endemic areas of tropical and subtropical zones. In the past, only a few single case reports of articular melioidosis were published in English journals, and almost all were secondary to melioidosis of another organ. Accurate diagnosis of this infection is important because a high mortality rate is usually associated with the septicemic form. Nine cases of isolated articular involvement were diagnosed between 1984 and 1988 in Northeast Thailand. Symptoms were subtle and diagnosis required a high degree of suspicion. Diagnosis depended on bacteriologic methods including Gram's stain, pus and blood cultures, and on an indirect hemagglutination titer of over 1:40. In addition to general measures for septic arthritis, antibiotic therapy using a combination of intravenous cotrimoxazole, doxycycline, and chloramphenicol was generally satisfactory. Second line drugs (i.e., more effective but also more expensive drugs that the authors administered when patients failed to respond to the first line drugs cotrimoxazole, doxycycline, and chloramphenicol) comprising intravenous ceftazidime and cotrimoxazole were administered in cases with an underlying disease. Comparison of the disease course before and during hospitalization as well as the total days of treatment between two small groups of patients with and without underlying disease revealed no statistically significant difference.
Insights
Melioidosis, a serious infection caused by Pseudomonas pseudomallei, can affect joints. Early diagnosis and appropriate antibiotic treatment are crucial for managing this potentially fatal disease.
Area of Science:
- Infectious Diseases
- Microbiology
- Rheumatology
Background:
- Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative bacterium.
- It is increasingly diagnosed in non-endemic regions and can cause severe, fatal infections.
- Articular melioidosis, particularly isolated joint involvement, is rare and often secondary to other infections.
Purpose of the Study:
- To describe the clinical presentation, diagnosis, and treatment of isolated articular melioidosis.
- To highlight the importance of high suspicion for accurate diagnosis.
- To evaluate treatment outcomes in patients with and without underlying diseases.
Main Methods:
- Retrospective case series of nine patients diagnosed with isolated articular melioidosis between 1984 and 1988 in Northeast Thailand.
- Diagnostic methods included Gram's stain, pus and blood cultures, and indirect hemagglutination titers.
- Treatment involved initial intravenous antibiotics (cotrimoxazole, doxycycline, chloramphenicol) with second-line options (ceftazidime, cotrimoxazole) for refractory cases.
Main Results:
- Nine cases of isolated articular melioidosis were identified, with subtle symptoms requiring high clinical suspicion.
- Bacteriologic methods and serologic titers were key to diagnosis.
- Initial antibiotic regimens were generally satisfactory, with second-line drugs used for specific cases.
- No significant difference in disease course or treatment duration was observed between patients with and without underlying diseases.
Conclusions:
- Isolated articular melioidosis can be diagnosed using bacteriologic and serologic methods.
- Prompt antibiotic therapy, including combinations like cotrimoxazole, doxycycline, and chloramphenicol, is effective.
- Early and accurate diagnosis is vital for managing this potentially life-threatening infection, even in non-endemic areas.