Abstract
Aim
Melioidosis is a significant public health problem in endemic regions such as India. Lack of awareness, predominant empiric antibiotic use reducing culture yields, morphotypic variability of cultures and frequent misidentification by automated blood culture systems, pose myriad challenges in diagnosis and treatment. Through this series, we present our experience of Hematogenous Osteomyelitis with Burkholderia pseudomallei.
Method
This was a single centre, retrospective, observational study performed at a tertiary case hospital in Mumbai, India from June 2011 to June 2021.
Results
The study comprised of 7 cases (6:1, M: F). Mean age was 53.7 years (5 to 75). All had an underlying co- morbidity or were immunosuppressed. 3 patients were misidentified by automated systems prior to presentation (e coli, burkholderia cepacieae, acinetobacter). Most common site of infection was femur (n= 3), followed by tibia and foot and ankle (n= 2, each). One had disseminated meliodosis involving the spleen, lymph nodes, pulmonary) in addition to involvement of bilateral feet and ankles. B. pseudomallei was identified in all following surgical debridement at our institute. Each patient underwent mean 2 procedures. 3 needed local rotation flap surgeries for wound cover. All were treated with ceftazidime along with trimethoprim- sulfamethoxazole (TMP- SMX) during the 6 week induction phase. TMP- SMX was continued for a further 6 months in the consolidation phase. All patients had infection remission at a mean 19.3 months follow up. There were no mortalities in our series.
Conclusions
Clinically Burkholderia infections mimic other pyogenic infections, Gram-negative sepsis, tuberculosis and has been referred to as the “remarkable imitator” and the “mimicker of maladies”. Diabetes and alcoholism are risk factors. The need for diagnosing this entity is due to the fact that the septicemic form has a mortality rate that exceeds 90%. Melioidosis is frequently misidentified. A high clinical suspicion, communication with microbiologist, knowledge about the biochemical, cultural and phenotypic susceptibility patterns may help in optimising diagnosis. Adequate debridement coupled with targeted prolonged antibiotics help achieve good outcomes.
