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Burkholderia Pseudomallei Causing Bone and Joint Infections: A Clinical Update
Nadeem Sajjad Raja1, Christine Scarsbrook2
1Department of Microbiology, Medway and Maritime Hospital NHS Trust, Windmill Road, Gillingham, Kent, UK. nadeem.raja@nhs.net.
Abstract:
Burkholderia pseudomallei (B. pseudomallei), a causative agent of an emerging infectious disease melioidosis, is endemic in the tropical regions of the world. Due to increased international travel, the infection is now also seen outside of the tropics. The majority of patients with identified risk factors such as diabetes mellitus, heavy alcohol use, malignancy, chronic lung and kidney disease, corticosteroid use, thalassemia, rheumatic heart disease, systemic lupus erythematosus and cardiac failure acquire this organism through percutaneous inoculation or inhalation. The clinical manifestations are variable, ranging from localized abscess formation to septicemia. Melioidotic bone and joint infections are rarely reported but are an established entity. The knee joint is the most commonly affected joint in melioidosis, followed by the ankle, hip and shoulder joints. Melioidosis should be in the differential diagnosis of bone and joint infections in residents or returning travelers from the endemic area. Melioidosis diagnosis is missed in many parts of the world due to the lack of awareness of this infection and limited laboratory training and diagnostic techniques. It also mimics other diseases such as tuberculosis. Delay in the diagnosis, or the initiation of appropriate and effective treatment against melioidosis, could worsen the outcome. Initial therapy with ceftazidime, or carbapenem with or without cotrimoxazole is recommended, followed by the oral eradication therapy (based on the antimicrobial susceptibility) with amoxicillin/clavulanic acid or cotrimoxazole. Surgical intervention remains important. This paper reviews current literature on the epidemiology, clinical features, diagnosis, and management of melioidotic bone and joint infections.
Insights
Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease affecting bone and joints, particularly in tropical regions. Early diagnosis and appropriate antibiotic treatment are crucial for better outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedics
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease endemic in tropical regions, increasingly seen globally due to travel.
- Risk factors include diabetes, alcohol use, and chronic diseases, with infection acquired via inoculation or inhalation.
- Melioidotic bone and joint infections, though rarely reported, are an established entity, commonly affecting the knee.
Purpose of the Study:
- To review the current literature on the epidemiology, clinical features, diagnosis, and management of melioidotic bone and joint infections.
- To highlight the importance of considering melioidosis in the differential diagnosis of bone and joint infections, especially in travelers.
- To emphasize the challenges in diagnosis and the need for increased awareness and improved laboratory techniques.
Main Methods:
- Comprehensive review of existing literature on melioidotic bone and joint infections.
- Analysis of epidemiological data, clinical presentations, diagnostic approaches, and treatment strategies.
- Synthesis of information on recommended antimicrobial therapies and the role of surgery.
Main Results:
- Melioidosis presents with variable clinical manifestations, from localized abscesses to septicemia, with bone and joint involvement being less common but significant.
- The knee is the most frequently affected joint, followed by the ankle, hip, and shoulder.
- Delayed diagnosis and treatment can lead to poor outcomes, underscoring the need for prompt recognition and management.
Conclusions:
- Melioidosis should be considered in the differential diagnosis of bone and joint infections in endemic area residents and travelers.
- Awareness, improved diagnostics, and timely initiation of appropriate antibiotic therapy (ceftazidime, carbapenems, cotrimoxazole) and surgical intervention are critical.
- Effective management involves initial intravenous therapy followed by oral eradication therapy.
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