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Category: Volume 07 Issue 07 July 2019
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Title: Concomitant Staphylococcus aureus and Burkholderia pseudomallei infection causing multifocal osteomyelitis a rare presentation of melioidosis in an uncontrolled diabetic host- case series

Authors: Sharandeep Singh Saluja, M. Mohan kumar, Sridhar Gopal

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.05

Abstract

Introduction: Melioidosis is a potentially fatal infectious disease caused by a soil transmitted saprophyte Burkholderia pseudomallei, a Gram-negative bacillus with bipolar staining. Melioidosis has expanded its occurrence from the tropics to other parts of the world. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids  in patient with  risk factors  such as Diabetes mellitus, heavy alcohol use, smoking, chronic lung and kidney disease, corticosteroid use. This organism is acquired through percutaneous inoculation and inhalation. Meliodosis can present with septicemia, visceral abscesses, cavitory pneumonia and rarely multifocal osteomyelitis.

Aims and Objectives: Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues.Objective of this study  is early diagnosis and  to start appropriate treatment in  patient with  melioidosis.

Material and Method: During a period of two years (March 2017 to April 2019), we had seven patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis cause by concomitant staphylocococcus aureus and burkholderia pseudomallei organism. All patients were diagnosed on the basis of clinical, microbiological and radiological correlation. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid and co-trimoxazole and doxycycline) for minimum period of three months to maximum period of six months. All patient were followed up for a period ofone year and all patients recovered completely with no recurrences.

Result: With early diagnosis and appropriate treatment all patient were cured of the infection with no recurrence.

Conclusion: Diagnosis of Melioidosis missed in many parts of the world due to lack of awareness of this infection and lack of adequate diagnostic techniques. It mimics other disease such as tuberculosis and infections caused by Staphylococcus aureus. Delay in diagnosis or treatment against melioidosis can worsen the outcome. Initial therapy with intravenous antibiotics followed by oral maintenance therapy and appropriate surgical intervention remains vital in the management.

Keywords: Burkholderia pseudomallei, melioidosis, musculoskeletal infection.

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Corresponding Author

Sharandeep Singh Saluja

Post graduate student, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India