The Journal of Bone and Joint Surgery, Vol 75, Issue 12 1811-1815, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Musculoskeletal melioidosis
W Kosuwon, S Saengnipanthkul, B Mahaisavariya, W Laupattarakasem and K Kaen
Department of Orthopaedics and Rehabilitation Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
During a four-year period, twenty-one patients were found to have
melioidosis of the musculoskeletal system caused by Pseudomonas
pseudomallei. The melioidotic patients were matched with thirty-nine
patients who had a musculoskeletal infection due to some other organism,
and the two groups were compared with regard to the presence of concurrent
disease. The indirect hemagglutination test for melioidosis was positive
for all of the melioidotic patients; in thirteen, cultures also were
positive. For the patients who did not have melioidosis, the diagnosis was
made on the basis of positive cultures of other organisms or histological
sections. In most of the non-melioidotic patients, the infection was due to
Staphylococcus aureus (twenty-four patients) or to Mycobacterium
tuberculosis (twelve patients). The most common concurrent diseases in the
melioidotic patients were diabetes and thalassemia. The odds that
melioidosis was the cause of the infection in a patient who had a
concurrent disease were twelve to one. All melioidotic patients were
managed with operative debridement and a combination of drugs--usually,
trimethoprim and sulfamethoxazole, doxycycline, and kanamycin or
chloramphenicol--for six months. The mean duration of follow-up was one and
one-half years. Of the twenty-one patients, eighteen had an excellent or
good result in terms of motion of the joint and absence of relapse.
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