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Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India.

Pandey V, Rao SP, Rao S, Acharya KK, Chhabra SS - Indian J Orthop (2010)

Bottom Line: All patients were diagnosed on the basis of positive pus culture.All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia.All other patients recovered completely with no recurrences.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopadics, Kasturba Medical College, Manipal, Karnataka - 576 104, India.

ABSTRACT
Melioidosis, an infection due to gram negative Burkholderia pseudomallei, is an important cause of sepsis in east Asia especially Thailand and northern Australia. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids especially in patients with diabetes, chronic renal failure and thalassemia. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. During a two-year-period, we had five patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis. One patient died early because of septicemia and multi-organ failure. All patients were diagnosed on the basis of positive pus culture. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia. All other patients recovered completely with no recurrences. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.

No MeSH data available.


Related in: MedlinePlus

Gram stain picture showing black arrow pointing a bipolar stained B. pseudomallei
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Figure 0002: Gram stain picture showing black arrow pointing a bipolar stained B. pseudomallei

Mentions: A 29-year-old male shopkeeper presented with left thigh pain of one-year duration with intermittent fever. Clinically, there was local rise in temperature at mid-thigh with no skin changes or sinuses. Mid-shaft of left femur was thick and tender. Rotational range of motion at hip was full but flexion (0-100°) and abduction (0-30°) were limited. Knee range of motion was 5-100°. His hemoglobin was 12.3 gm% and erythrocyte sedimentation rate (ESR) was 64 mm/h. His serology was negative for HIV. He was nondiabetic. X-ray revealed thickening of mid-shaft femoral cortex [Figure 1a]. Computed tomography scan (CT scan), magnetic resonance imaging (MRI) and bone scan were not asked as the clinical and radiological evidence pointed towards localized osteomyelitis. He underwent curettage and decompression of the femur. Biopsy of the lesion was reported as chronic non-tubercular granulomatous osteomyelitis or Garre's osteomyelitis as differential diagnosis. The local culture was negative for any bacterial, tubercular or fungal growth. Patient was kept on intravenous (IV) cefotaxime and later followed by oral cefuroxime for four weeks. His symptoms reappeared after six months. He underwent repeat curettage and this time, the culture from local site was positive for Burkholderia pseudomallei. Gram staining revealed typical bipolar stained B. pseudomallei organisms [Figure 2]. After initial three weeks of I.V. ciprofloxacin and amoxy-clavulanic acid, according sensitivity, he was kept on co-trimoxazole for six months with complete clinical and biochemical parameter recovery. His thigh pain and swelling subsided. Range of movement at knee and hip returned to full range and painless. His ESR at final follow-up was 16 mm/h. He has been asymptomatic for 30 months. His final X-ray reveals healed lesion [Figure 1b].


Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India.

Pandey V, Rao SP, Rao S, Acharya KK, Chhabra SS - Indian J Orthop (2010)

Gram stain picture showing black arrow pointing a bipolar stained B. pseudomallei
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2856400&req=5

Figure 0002: Gram stain picture showing black arrow pointing a bipolar stained B. pseudomallei
Mentions: A 29-year-old male shopkeeper presented with left thigh pain of one-year duration with intermittent fever. Clinically, there was local rise in temperature at mid-thigh with no skin changes or sinuses. Mid-shaft of left femur was thick and tender. Rotational range of motion at hip was full but flexion (0-100°) and abduction (0-30°) were limited. Knee range of motion was 5-100°. His hemoglobin was 12.3 gm% and erythrocyte sedimentation rate (ESR) was 64 mm/h. His serology was negative for HIV. He was nondiabetic. X-ray revealed thickening of mid-shaft femoral cortex [Figure 1a]. Computed tomography scan (CT scan), magnetic resonance imaging (MRI) and bone scan were not asked as the clinical and radiological evidence pointed towards localized osteomyelitis. He underwent curettage and decompression of the femur. Biopsy of the lesion was reported as chronic non-tubercular granulomatous osteomyelitis or Garre's osteomyelitis as differential diagnosis. The local culture was negative for any bacterial, tubercular or fungal growth. Patient was kept on intravenous (IV) cefotaxime and later followed by oral cefuroxime for four weeks. His symptoms reappeared after six months. He underwent repeat curettage and this time, the culture from local site was positive for Burkholderia pseudomallei. Gram staining revealed typical bipolar stained B. pseudomallei organisms [Figure 2]. After initial three weeks of I.V. ciprofloxacin and amoxy-clavulanic acid, according sensitivity, he was kept on co-trimoxazole for six months with complete clinical and biochemical parameter recovery. His thigh pain and swelling subsided. Range of movement at knee and hip returned to full range and painless. His ESR at final follow-up was 16 mm/h. He has been asymptomatic for 30 months. His final X-ray reveals healed lesion [Figure 1b].

Bottom Line: All patients were diagnosed on the basis of positive pus culture.All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia.All other patients recovered completely with no recurrences.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopadics, Kasturba Medical College, Manipal, Karnataka - 576 104, India.

ABSTRACT
Melioidosis, an infection due to gram negative Burkholderia pseudomallei, is an important cause of sepsis in east Asia especially Thailand and northern Australia. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids especially in patients with diabetes, chronic renal failure and thalassemia. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. During a two-year-period, we had five patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis. One patient died early because of septicemia and multi-organ failure. All patients were diagnosed on the basis of positive pus culture. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia. All other patients recovered completely with no recurrences. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.

No MeSH data available.


Related in: MedlinePlus