Gupta Nitin, Bhat Shyamasunder N, Reddysetti Suhas, Kadavigere Rajagopal, Godkhindi Vishwapriya M, Mukhopadhyay Chiranjay, Saravu Kavitha
Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Infez Med. 2021 Dec 10;29(4):574-582. doi: 10.53854/liim-2904-11. eCollection 2021.
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.
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.
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.
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.
类鼻疽患者可出现发热、呼吸窘迫和局灶性受累的综合症状。然而，骨和关节的局灶性受累在类鼻疽患者中较为罕见。本研究旨在对骨关节炎类鼻疽患者进行特征描述。
这是一项对三年内所有诊断为培养阳性的骨关节炎类鼻疽成年患者记录的回顾性研究。临床、实验室和治疗细节记录在预定义的病例记录表中并进行分析。
在11例骨关节炎类鼻疽患者中，55%（n = 6）同时有肺部受累。患者被分类为孤立性骨髓炎（n = 3）、孤立性关节炎（n = 3）以及骨髓炎和化脓性关节炎两者皆有（n = 5）。在8例有关节受累的患者中，87.5%为单关节炎。75%有骨受累的患者（n = 8）仅累及一块骨头。36.4%（n = 4）的病例伴有肌炎。54.5%（n = 6）的病例对受累的骨或关节进行了局部清创。头孢他啶/美罗培南与复方新诺明联合治疗主要用作强化治疗，平均疗程为3 + 1.3周。复方新诺明单药治疗用作根除治疗，平均疗程为4.6 + 2个月。除1例复发患者和1例死亡患者外，所有患者在治疗结束时均被宣布治愈。
来自流行地区的高危个体若出现单骨或单关节受累及周围肌炎，应怀疑骨关节炎类鼻疽。早期诊断和及时开始治疗是获得良好疗效的关键。
