Clin Orthop Surg.  2017 Sep;9(3):386-391. 10.4055/cios.2017.9.3.386.

Clinical Outcomes in Musculoskeletal Involvement of Burkholderia Pseudomallei Infection

• Gouse M
• Jayasankar V
• Patole S
• Veeraraghavan B
• Nithyananth M

• KMID: 2412276
• DOI: http://doi.org/10.4055/cios.2017.9.3.386

Abstract

BACKGROUND
Musculoskeletal involvement in melioidosis is often seen in conjunction with a disseminated illness. Recent reports suggest that operative management of musculoskeletal melioidosis has favourable results. The purpose of this study was to review the patient profile and clinical outcomes of Burkholderia pseudomallei infection in the musculoskeletal system.
METHODS
Hospital records of 163 patients who were diagnosed to have B. pseudomallei infection between January 2009 and December 2014 were reviewed. Patients underwent surgical and nonsurgical management depending upon the tissue of involvement. Epidata software was used to record the data. The SPSS ver. 17.0 was used for analysis.
RESULTS
Eighteen out of 24 patients who had musculoskeletal melioidosis were available for follow-up. Septic arthritis, osteomyelitis, and intramuscular abscess were the common diagnosis, with 6 patients in each group. Twelve patients required surgical intervention. All patients received a full course of parenteral ceftazidime followed by oral doxycycline and co-trimoxazole. Two out of 6 patients (33.3%) died among those who had nonsurgical management as compared to none in the group who had surgical management. This was significant at 10% level of significance (p = 0.098). The rest were followed up for a minimum of 1 year with no evidence of disease recurrence.
CONCLUSIONS
This series describing musculoskeletal involvement in melioidosis is the largest such study from a recently recognized "˜endemic' region. Of importance are the patterns of musculoskeletal involvement, pitfalls in diagnosis and adequate clinical response with timely diagnosis and appropriate surgical management.

Keyword

Burkholderia pseudomallei; Synovitis; Debridement; Osteomyelitis

MeSH Terms

Adolescent
Adult
*Burkholderia pseudomallei
Female
Humans
Male
Melioidosis/diagnostic imaging/microbiology/*pathology/surgery
Middle Aged
Musculoskeletal Diseases/diagnostic imaging/*microbiology/pathology/surgery
Radiography
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Sinusogram showing a foci of osteomyelitis in the proximal femur.

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  Fig. 2 Osteomyelitis of the proximal humerus on plain radiography (A) and magnetic resonance imaging (B).

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  Fig. 3 Serial radiographs of a patient with distal femur osteomyelitis. (A) Post-debridement radiographs. (B) The patient developed a fracture of the distal femur 2 months after debridement. (C) The fracture was fixed and showed uncomplicated union.

Reference

1. Suputtamongkol Y, Hall AJ, Dance DA, et al. The epidemiology of melioidosis in Ubon Ratchatani, northeast Thailand. Int J Epidemiol. 1994; 23(5):1082–1090. PMID: 7860160.

2. Whitmore A, Krishnaswami CS. An account of the discovery of a hitherto undescribed infectious disease among the population of Rangoon. Ind Med Gaz. 1912; 47:262–267.

3. Cheng AC, Hanna JN, Norton R, et al. Melioidosis in northern Australia, 2001-02. Commun Dis Intell Q Rep. 2003; 27(2):272–277. PMID: 12926743.

4. Leelarasamee A, Trakulsomboon S, Kusum M, Dejsirilert S. Isolation rates of Burkholderia pseudomallei among the four regions in Thailand. Southeast Asian J Trop Med Public Health. 1997; 28(1):107–113.

5. Raghavan KR, Shenoi RP, Zaer F, Aiyer R, Ramamoorthy P, Mehta MN. Melioidosis in India. Indian Pediatr. 1991; 28(2):184–188. PMID: 2055637.

6. John TJ, Jesudason MV, Lalitha MK, et al. Melioidosis in India: the tip of the iceberg? Indian J Med Res. 1996; 103:62–65. PMID: 8926030.

7. Punyagupta S. Melioidosis: review of 686 cases and presentation of a new clinical classification. In : Punyagupta S, Sirisanthana T, Stapatayavong B, editors. Melioidosis. Bangkok, Thailand: Bangkok Medical;1989. p. 217–229.

8. Chaowagul W, White NJ, Dance DA, et al. Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. J Infect Dis. 1989; 159(5):890–899. PMID: 2708842.

9. Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012; 367(11):1035–1044. PMID: 22970946.

10. Chrispal A, Rajan SJ, Sathyendra S. The clinical profile and predictors of mortality in patients with melioidosis in South India. Trop Doct. 2010; 40(1):36–38. PMID: 19850605.

11. Mukhopadhyay C, Dey A, Sugandhi Rao P, Pandey V, Sripathi Rao P. Aetiology and management of chronic granulomatous osteomyelitis: look before you leap. Singapore Med J. 2007; 48(2):e40–e42. PMID: 17304376.

12. Pandey V, Rao SP, Rao S, Acharya KK, Chhabra SS. Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India. Indian J Orthop. 2010; 44(2):216–220. PMID: 20419012.

13. Ng WM, Kwan MK, Merican AM. Melioidotic osteomyelitis treated with antibiotic-calcium hydroxyapatite composite: case report with four-year follow-up. Singapore Med J. 2006; 47(1):71–74. PMID: 16397726.

14. Subhadrabandhu T, Prichasuk S, Sathapatayavongs B. Localised melioidotic osteomyelitis. J Bone Joint Surg Br. 1995; 77(3):445–449. PMID: 7744934.

15. White NJ, Dance DA, Chaowagul W, Wattanagoon Y, Wuthiekanun V, Pitakwatchara N. Halving of mortality of severe melioidosis by ceftazidime. Lancet. 1989; 2(8665):697–701. PMID: 2570956.

16. Chetchotisakd P, Chierakul W, Chaowagul W, et al. Trimethoprim-sulfamethoxazole versus trimethoprim-sulfamethoxazole plus doxycycline as oral eradicative treatment for melioidosis (MERTH): a multicentre, double-blind, non-inferiority, randomised controlled trial. Lancet. 2014; 383(9919):807–814. PMID: 24284287.

17. Cheng AC, Limmathurotsakul D, Chierakul W, et al. A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. Clin Infect Dis. 2007; 45(3):308–314. PMID: 17599307.

18. Currie BJ, Fisher DA, Howard DM, et al. Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature. Clin Infect Dis. 2000; 31(4):981–986. PMID: 11049780.