Non-Caseating Granulomatous Infective Spondylitis: Melioidotic Spondylitis.

Area of Science:

• Infectious Diseases
• Spinal Surgery
• Microbiology

Background:

• Melioidosis, caused by *Burkholderia pseudomallei*, is an emerging infectious disease with high mortality, prevalent in developing nations.
• *Burkholderia pseudomallei* is recognized as a potential bio-terrorism agent.
• Spinal involvement (spondylitis) is a serious manifestation of melioidosis.

Purpose of the Study:

• To describe the clinical presentation of melioidosis affecting the spine.
• To raise awareness among healthcare professionals, especially spine surgeons, about diagnosing and treating melioidotic spondylitis.

Main Methods:

• Retrospective analysis of culture-positive *B. pseudomallei* patients.
• Evaluation of clinical, radiological (plain radiography, MRI), and blood parameters (ESR, CRP).
• Assessment included pain, neurological deficits, and return to work.

Main Results:

• Four patients with melioidosis and spondylitis were analyzed; all had diabetes mellitus.
• Clinical and radiological findings mimicked tuberculous spondylitis, including back pain, spondylodiscitis, and abscesses.
• Bacteriological cultures confirmed *B. pseudomallei*, and histopathology revealed non-caseating granulomatous inflammation.

Conclusions:

• Melioidotic spondylitis presents similarly to tuberculosis, necessitating consideration in diabetic patients with suggestive features.
• Bacteriological culture and histopathology are key to differentiating melioidosis from tuberculosis.
• Enhanced awareness and education for healthcare professionals are vital for accurate diagnosis and management.