Osteoarticular melioidosis: a retrospective cohort study of a neglected disease.

Introduction: Patients with melioidosis can present with a combination of fever, respiratory distress and focal involvement. Focal involvement of bone and joint is, however, rare in patients with melioidosis. This study aimed to characterize patients with osteoarticular melioidosis.

Patients And Methods: This was a retrospective review of records of all adult patients diagnosed with culture-positive osteoarticular melioidosis over three years. The clinical, laboratory and treatment details were recorded in a predefined case-record form and analyzed.

Results: Of the 11 patients with osteoarticular melioidosis, 55% (n=6) had concurrent pulmonary involvement. The patients were classified as isolated osteomyelitis (n=3), isolated arthritis (n=3), and both osteomyelitis and septic arthritis (n=5). Of eight patients with joint involvement, 87.5% had monoarthritis. A single bone was involved in 75% of the patients with bone involvement (n=8). Concomitant myositis was seen in 36.4% (n=4) of the cases. Local debridement of the involved bone or joint was done in 54.5% (n=6) of the cases. Combination therapy with ceftazidime/meropenem and cotrimoxazole was predominantly used as intensive therapy for a mean of 3+1.3 weeks. Monotherapy with cotrimoxazole was used as eradication therapy for a mean of 4.6+2 months. Except for one patient with recurrent disease and one death, all patients were declared cured at the end of therapy.

Conclusion: Osteoarticular melioidosis should be suspected in high-risk individuals from endemic areas with single bone or joint involvement and surrounding myositis. Early diagnosis and prompt initiation of therapy is key to a favourable response.