Kosuwon Weerachai, Taimglang Twatchai, Sirichativapee Winia, Jeeravipoolvarn Polasak
Department of Orthopedics, Khon Kaen University, Khon Kaen 40002, Thailand.
J Bone Joint Surg Am. 2003 Jun;85(6):1058-61. doi: 10.2106/00004623-200306000-00011.
Melioidotic septic arthritis is an infection caused by the gram-negative bacillus Burkholderia pseudomallei. It is commonly found in Northeast Thailand. The goal of our study was to identify specific characteristics of patients with melioidotic septic arthritis by comparing them with patients with non-melioidotic septic arthritis and to describe the results of treatment of melioidotic septic arthritis.
We conducted a retrospective study of seventy-seven patients with septic arthritis who were treated in our hospital over a period of four years. Twenty-five of the patients had melioidotic septic arthritis, and fifty-two had non-melioidotic septic arthritis. Univariate and multivariate analyses were conducted to identify the risk factors for melioidotic septic arthritis, and the clinical course of the twenty-five patients with melioidotic septic arthritis was followed until the infection resolved.
Patients with melioidotic septic arthritis differed significantly (p = 0.002 ) from those with non-melioidotic septic arthritis with regard to the frequency of diabetes mellitus and of involvement of an upper-extremity joint. The odds ratio that melioidosis was the cause of the infection was 15.7 (95% confidence interval, 4.5 to 55.6) in a patient with diabetes mellitus and 4.51 (95% confidence interval, 1.04 to 19.65) in a patient with involvement of an upper-extremity joint. Twenty-two of the twenty-five patients with melioidotic septic arthritis responded to treatment, which consisted of six months of antibiotic therapy combined with needle aspiration, as well as surgical drainage of the affected joint when necessary (sixteen patients).
A diagnosis of melioidotic septic arthritis should be considered when septic arthritis is seen in an individual who is indigenous to or has recently visited Southeast Asia. The infection is more likely to be melioidotic septic arthritis if it involves an upper-extremity joint and if the patient has diabetes mellitus.
类鼻疽性化脓性关节炎是由革兰氏阴性杆菌类鼻疽伯克霍尔德菌引起的一种感染。该病常见于泰国东北部。我们研究的目的是通过将类鼻疽性化脓性关节炎患者与非类鼻疽性化脓性关节炎患者进行比较，来确定类鼻疽性化脓性关节炎患者的具体特征，并描述类鼻疽性化脓性关节炎的治疗结果。
我们对在四年期间于我院接受治疗的77例化脓性关节炎患者进行了一项回顾性研究。其中25例患者患有类鼻疽性化脓性关节炎，52例患有非类鼻疽性化脓性关节炎。进行单因素和多因素分析以确定类鼻疽性化脓性关节炎的危险因素，并对25例类鼻疽性化脓性关节炎患者的临床病程进行随访直至感染消退。
类鼻疽性化脓性关节炎患者在糖尿病发病率和上肢关节受累方面与非类鼻疽性化脓性关节炎患者有显著差异（p = 0.002）。糖尿病患者感染由类鼻疽病引起的比值比为15.7（95%置信区间，4.5至55.6），上肢关节受累患者的比值比为4.51（95%置信区间，1.04至19.65）。25例类鼻疽性化脓性关节炎患者中有22例对治疗有反应，治疗包括六个月的抗生素治疗联合针吸术，必要时（16例患者）对受累关节进行手术引流。
当在东南亚本地人或近期去过东南亚的个体中发现化脓性关节炎时，应考虑类鼻疽性化脓性关节炎的诊断。如果感染累及上肢关节且患者患有糖尿病，则更有可能是类鼻疽性化脓性关节炎。
