Raja Nadeem Sajjad
Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
J Microbiol Immunol Infect. 2007 Apr;40(2):178-82.
Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in southeast Asia and northern Australia. In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare but well-recognized manifestation of melioidosis. Patients with underlying medical conditions, such as diabetes mellitus, renal impairment, cirrhosis, and malignancy are at greater risk. The presentations of melioidotic septic arthritis often mimic other disease processes and patients may not always be clinically septic. We present a case of septic arthritis due to B. pseudomallei in a 66-year-old male with diabetes mellitus presenting with a history of fever and ankle swelling. Follow-up ankle X-ray showed soft tissue swelling. Synovial fluid and blood samples grew B. pseudomallei. The patient improved gradually after parenteral administration of ceftazidime (2 g 8-hourly) and cotrimoxazole (1440 mg 8-hourly). He was discharged on oral cotrimoxazole (1440 mg 12-hourly), doxycycline (100 mg 12-hourly), and chloramphenicol (500 mg 6-hourly) for 6 months. This case highlights the possible occurrence of melioidotic septic arthritis, and the importance of prompt initiation of appropriate antimicrobials to achieve good outcomes.
类鼻疽杆菌是类鼻疽病的病原体，在东南亚和澳大利亚北部地区呈地方性流行。近年来，类鼻疽病在全球范围内的发病率有所上升。化脓性关节炎是类鼻疽病一种罕见但已被充分认识的表现形式。患有糖尿病、肾功能损害、肝硬化和恶性肿瘤等基础疾病的患者风险更高。类鼻疽性化脓性关节炎的表现常常类似于其他疾病过程，患者临床上不一定总是有败血症表现。我们报告一例66岁患糖尿病男性因类鼻疽杆菌导致的化脓性关节炎病例，该患者有发热和踝关节肿胀病史。随访踝关节X线显示软组织肿胀。滑液和血液样本培养出类鼻疽杆菌。经静脉注射头孢他啶（每8小时2克）和复方新诺明（每8小时1440毫克）后，患者逐渐好转。患者出院时口服复方新诺明（每12小时1440毫克）、强力霉素（每12小时100毫克）和氯霉素（每6小时500毫克），疗程6个月。该病例突出了类鼻疽性化脓性关节炎可能发生的情况，以及及时开始使用适当抗菌药物以取得良好治疗效果的重要性。
