Jayakumar B, P Ajay James
Department of Orthopaedics, Aarupadai Veedu Medical College, Puducherry, India.
J Orthop Case Rep. 2022 Dec;12(12):77-82. doi: 10.13107/jocr.2022.v12.i12.3472.
Burkholderia pseudomallei is a gram-negative bacillus. It is predominant in Southeast Asia and Australia. Melioidosis of the hip joint is a very rare condition. This case report is to the best of our knowledge, the only study showcasing an acute proximal femoral osteomyelitis of the hip joint caused by Burkholderia pseudomallei.
A 47-year-old male, a known case of diabetes mellitus since 7 years, presented with fever for 2 weeks and pain over left hip for 10 days. He gave a history of treatment for typhoid fever with multiple intravenous and intramuscular injections, 1 month before his present symptoms. On Examination: His left hip joint was tender and all movements of the hip were restricted. His blood investigations revealed high counts (TC=10,150), erythrocyte sedimentation rate (116), and a positive C-reactive protein (CRP). X-ray of the hip joint was normal. An magnetic resonance imaging (MRI) of the hip joint showed bone marrow edema and infiltrates of the left proximal femur, suggestive of an osteomyelitis. The patient was treated with an initial open bone biopsy and culture, which was reported as no growth. Due to persistent surgical site infection, a repeat pus culture and sensitivity yielded growth of Burkholderia pseudomallei. Hence, a wound debridement, bone curettage, and antibiotic cement bead application (Using vancomycin and tobramycin) was done. The wound healed well, and the CRP values and counts dropped rapidly to become normal. Oral cotrimoxazole was started as per the eradication regime. The cement beads were removed after 2 months. A repeat MRI done after 1 month showed that the collection in the left femur was resolving. The patient was treated with injection ceftazidime (1 g Iv Bd X 3 weeks) and was advised to continue oral cotrimoxazole for a total of 6 months.
Isolated bone infection caused by Burkholderia pseudomallei is probably underreported in India. It has a variable presentation and closely mimics tuberculosis. Its early diagnosis, early aggressive surgical treatment, and prolonged antibiotic administration are vital to prevent the chronicity of this infection and decrease the morbidity.
伯克霍尔德菌是一种革兰氏阴性杆菌。它在东南亚和澳大利亚较为常见。髋关节类鼻疽病是一种非常罕见的病症。据我们所知，本病例报告是唯一一项展示由伯克霍尔德菌引起的急性近端股骨骨髓炎的研究。
一名47岁男性，患糖尿病7年，出现发热2周，左髋疼痛10天。他自述在出现当前症状前1个月曾因伤寒接受多次静脉和肌肉注射治疗。检查发现：其左髋关节压痛，髋关节所有活动均受限。血液检查显示白细胞计数高（TC = 10,150）、红细胞沉降率高（116）以及C反应蛋白（CRP）呈阳性。髋关节X线检查正常。髋关节磁共振成像（MRI）显示左近端股骨骨髓水肿和浸润，提示骨髓炎。患者最初接受了开放性骨活检和培养，报告为无生长。由于手术部位持续感染，再次进行脓液培养及药敏试验，培养出伯克霍尔德菌。因此，进行了伤口清创、骨刮除术，并应用了抗生素骨水泥珠（使用万古霉素和妥布霉素）。伤口愈合良好，CRP值和白细胞计数迅速下降至正常。按照根除方案开始口服复方新诺明。2个月后取出骨水泥珠。1个月后再次进行MRI检查显示左股骨内的积液正在吸收。患者接受了头孢他啶注射治疗（1克静脉注射，每日两次，共3周），并被建议继续口服复方新诺明总共6个月。
在印度，由伯克霍尔德菌引起的孤立性骨感染可能未得到充分报告。其表现多样，与结核病极为相似。早期诊断、早期积极的手术治疗以及延长抗生素使用时间对于预防这种感染的慢性化和降低发病率至关重要。
