Wooten M D, Panwalker A P
Section of Rheumatology, Department of Veterans Affairs Regional Medical Center, Wilmington, Delaware 19805, USA.
J Clin Rheumatol. 2001 Aug;7(4):242-7. doi: 10.1097/00124743-200108000-00010.
We describe a case of septic arthritis and bacteremia caused by Burkholderia pseudomallei, a bacterium that is endemic in East Asia and northern Australia. We believe that dissemination occurred in our patient after surgical excision of a pulmonary nodule. Bacteremic melioidosis can present with musculoskeletal involvement in 2-10% of patients, but septic arthritis is uncommon. A review of the literature shows a total of 66 patients reported with septic arthritis caused by this organism. Patients with septic arthritis caused by Burkholderia pseudomallei were likely to have diabetes mellitus, and the knee is the joint most frequently affected by this organism. Recommended initial treatment consists of ceftazidime, alone or in combination with trimethoprim/sulfamethoxazole, high dose imipenem/cilastatin, or high dose cefoperazone/sulbactam. This is followed by a 12-20 week course of oral therapy (based on susceptibilities) to eradicate the organism. Most patients with subacute or latent disease do well after full antibiotic treatment, but relapses are common if full treatment is not given. Awareness of this disease is important even in areas outside of Asia given the increasing frequency of international travel and the growing likelihood of imported cases, along with an aging population of Vietnam veterans and immigrants.
我们描述了一例由伯克霍尔德菌引起的脓毒性关节炎和菌血症病例，该细菌在东亚和澳大利亚北部为地方病。我们认为，在我们的患者中，传播发生在肺结节手术切除之后。菌血症性类鼻疽在2%-10%的患者中可出现肌肉骨骼受累，但脓毒性关节炎并不常见。文献回顾显示，共有66例患者报告由该病原体引起脓毒性关节炎。由伯克霍尔德菌引起脓毒性关节炎的患者可能患有糖尿病，膝关节是最常受该病原体影响的关节。推荐的初始治疗包括单用头孢他啶或与甲氧苄啶/磺胺甲恶唑、高剂量亚胺培南/西司他丁或高剂量头孢哌酮/舒巴坦联合使用。随后进行12-20周的口服治疗疗程（根据药敏结果）以根除该病原体。大多数亚急性或潜伏性疾病患者在接受充分抗生素治疗后情况良好，但如果未进行充分治疗，复发很常见。鉴于国际旅行频率增加、输入病例可能性增大，以及越南退伍军人和移民人口老龄化，即使在亚洲以外地区，认识这种疾病也很重要。
