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Semin Musculoskelet Radiol 2011; 15(5): 480-488
DOI: 10.1055/s-0031-1293494
© Thieme Medical Publishers

Musculoskeletal Melioidosis

Nuttaya Pattamapaspong1 , Malai Muttarak1
  • 1Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Publication Date:
11 November 2011 (online)

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ABSTRACT

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed.

KEYWORDS

Burkholderia pseudomallei - infective arthritis - melioidosis - osteomyelitis

REFERENCES

  • 1 Whitemore A, Krishnaswami C. An account of the discovery of a hitherto undescribed infective disease occurring among the population of Rangoon.  Ind Med Gaz. 1912;  47 262-267
    Search in Google Scholar
  • 2 White N J. Melioidosis.  Lancet. 2003;  361 (9370) 1715-1722
    Search in Google Scholar
  • 3 Currie B J, Dance D A, Cheng A C. The global distribution of Burkholderia pseudomallei and melioidosis: an update.  Trans R Soc Trop Med Hyg. 2008;  102 (Suppl 1) S1-S4
    Search in Google Scholar
  • 4 Cheng A C, Currie B J. Melioidosis: epidemiology, pathophysiology, and management.  Clin Microbiol Rev. 2005;  18 (2) 383-416
    Search in Google Scholar
  • 5 Noah D L, Huebner K D, Darling R G, Waeckerle J F. The history and threat of biological warfare and terrorism.  Emerg Med Clin North Am. 2002;  20 (2) 255-271
    Search in Google Scholar
  • 6 Bondi S K, Goldberg J B. Strategies toward vaccines against Burkholderia mallei and Burkholderia pseudomallei. .  Expert Rev Vaccines. 2008;  7 (9) 1357-1365
    Search in Google Scholar
  • 7 Horn J K. Bacterial agents used for bioterrorism.  Surg Infect (Larchmt). 2003;  4 (3) 281-287
    Search in Google Scholar
  • 8 Cahn A, Koslowsky B, Nir-Paz R et al.. Imported melioidosis, Israel, 2008.  Emerg Infect Dis. 2009;  15 (11) 1809-1811
    Search in Google Scholar
  • 9 Peltroche-Llacsahuanga H, Haase G. A deadly thorn: a case of imported melioidosis.  Lancet. 1999;  353 (9157) 1016-1017
    Search in Google Scholar
  • 10 Popoff I, Nagamori J, Currie B. Melioidotic osteomyelitis in northern Australia.  Aust N Z J Surg. 1997;  67 (10) 692-695
    Search in Google Scholar
  • 11 Wuthiekanun V, Chierakul W, Rattanalertnavee J et al.. Serological evidence for increased human exposure to Burkholderia pseudomallei following the tsunami in southern Thailand.  J Clin Microbiol. 2006;  44 (1) 239-240
    Search in Google Scholar
  • 12 McCormick J B, Sexton D J, McMurray J G, Carey E, Hayes P, Feldman R A. Human-to-human transmission of Pseudomonas pseudomallei .  Ann Intern Med. 1975;  83 (4) 512-513
    Search in Google Scholar
  • 13 Abbink F C, Orendi J M, de Beaufort A J. Mother-to-child transmission of Burkholderia pseudomallei .  N Engl J Med. 2001;  344 (15) 1171-1172
    Search in Google Scholar
  • 14 Punyagupta S. Melioidosis: review of 686 cases and presentation of a new clinical classification. In: Punyagupta S, Sirisanthana T, Stapatayavong B, eds. Melioidosis. Bangkok, Thailand: Bangkok Medical; 1989: 217-229
    Search in Google Scholar
  • 15 Kosuwon W, Saengnipanthkul S, Mahaisavariya B, Laupattarakasem W, Kaen K. Musculoskeletal melioidosis.  J Bone Joint Surg Am. 1993;  75 (12) 1811-1815
    Search in Google Scholar
  • 16 Ngauy V, Lemeshev Y, Sadkowski L, Crawford G. Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during World War II.  J Clin Microbiol. 2005;  43 (2) 970-972
    Search in Google Scholar
  • 17 Teparrakkul P, Tsai J J, Chierakul W et al.. Rheumatological manifestations in patients with melioidosis.  Southeast Asian J Trop Med Public Health. 2008;  39 (4) 649-655
    Search in Google Scholar
  • 18 Dhiensiri T, Eua-Ananta Y. Visceral abscess in melioidosis.  J Med Assoc Thai. 1995;  78 (5) 225-231
    Search in Google Scholar
  • 19 Dhiensiri T, Puapairoj S, Susaengrat W. Pulmonary melioidosis: clinical-radiologic correlation in 183 cases in northeastern Thailand.  Radiology. 1988;  166 (3) 711-715
    Search in Google Scholar
  • 20 Sirikulchayanonta V, Subhadrabandhu T. Melioidosis. Another etiology of granulomatous osteomyelitis. Report of 2 cases.  Clin Orthop Relat Res. 1994;  (308) 183-186
    Search in Google Scholar
  • 21 Tan A P, Pui M H, Tan L K. Imaging patterns in melioidosis.  Australas Radiol. 1995;  39 (3) 260-264
    Search in Google Scholar
  • 22 Anuntagool N, Rugdech P, Sirisinha S. Identification of specific antigens of Pseudomonas pseudomallei and evaluation of their efficacies for diagnosis of melioidosis.  J Clin Microbiol. 1993;  31 (5) 1232-1236
    Search in Google Scholar
  • 23 Limmathurotsakul D, Chaowagul W, Day N P, Peacock S J. Patterns of organ involvement in recurrent melioidosis.  Am J Trop Med Hyg. 2009;  81 (2) 335-337
    Search in Google Scholar
  • 24 Peacock S J. Melioidosis.  Curr Opin Infect Dis. 2006;  19 (5) 421-428
    Search in Google Scholar
  • 25 Lazar Adler N R, Govan B, Cullinane M, Harper M, Adler B, Boyce J D. The molecular and cellular basis of pathogenesis in melioidosis: how does Burkholderia pseudomallei cause disease?.  FEMS Microbiol Rev. 2009;  33 (6) 1079-1099
    Search in Google Scholar
  • 26 Chaowagul W, Suputtamongkol Y, Dance D A, Rajchanuvong A, Pattara-arechachai J, White N J. Relapse in melioidosis: incidence and risk factors.  J Infect Dis. 1993;  168 (5) 1181-1185
    Search in Google Scholar
  • 27 Pruksachartvuthi S, Aswapokee N, Thankerngpol K. Survival of Pseudomonas pseudomallei in human phagocytes.  J Med Microbiol. 1990;  31 (2) 109-114
    Search in Google Scholar
  • 28 Sheridan E A, Ramsay A R, Short J M, Stepniewska K, Wuthiekanun V, Simpson A J. Evaluation of the Wayson stain for the rapid diagnosis of melioidosis.  J Clin Microbiol. 2007;  45 (5) 1669-1670
    Search in Google Scholar
  • 29 Ip M, Osterberg L G, Chau P Y, Raffin T A. Pulmonary melioidosis.  Chest. 1995;  108 (5) 1420-1424
    Search in Google Scholar
  • 30 Amornchai P, Chierakul W, Wuthiekanun V et al.. Accuracy of Burkholderia pseudomallei identification using the API 20NE system and a latex agglutination test.  J Clin Microbiol. 2007;  45 (11) 3774-3776
    Search in Google Scholar
  • 31 Chong V F, Fan Y F. The radiology of melioidosis.  Australas Radiol. 1996;  40 (3) 244-249
    Search in Google Scholar
  • 32 Pui M H, Tan A P. Musculoskeletal melioidosis: clinical and imaging features.  Skeletal Radiol. 1995;  24 (7) 499-503
    Search in Google Scholar
  • 33 Lim K S, Chong V H. Radiological manifestations of melioidosis.  Clin Radiol. 2010;  65 (1) 66-72
    Search in Google Scholar
  • 34 Nather A, David V, Hee H T, Thambiah J. Pyogenic vertebral osteomyelitis: a review of 14 cases.  J Orthop Surg (Hong Kong). 2005;  13 (3) 240-244
    Search in Google Scholar
  • 35 Subhadrabandhu T, Prichasuk S, Sathapatayavongs B. Localised melioidotic osteomyelitis.  J Bone Joint Surg Br. 1995;  77 (3) 445-449
    Search in Google Scholar
  • 36 Bielecki D K, Sartoris D, Resnick D, Van Lom K, Fierer J, Haghighi P. Intraosseous and intradiscal gas in association with spinal infection: report of three cases.  AJR Am J Roentgenol. 1986;  147 (1) 83-86
    Search in Google Scholar
  • 37 Chen C W, Yang C J, Huang J J, Chuang Y C, Young C. Gas-forming vertebral osteomyelitis in diabetic patients.  Scand J Infect Dis. 1991;  23 (2) 263-265
    Search in Google Scholar
  • 38 Putcharoen O, Suankratay C. Salmonella gas-forming femoral osteomyelitis and pyomyositis: the first case and review of the literature.  J Med Assoc Thai. 2007;  90 (9) 1943-1947
    Search in Google Scholar
  • 39 Wibulpolprasert B, Dhiensiri T. Visceral organ abscesses in melioidosis: sonographic findings.  J Clin Ultrasound. 1999;  27 (1) 29-34
    Search in Google Scholar
  • 40 Sangchan A, Mootsikapun P, Mairiang P. Splenic abscess: clinical features, microbiologic finding, treatment and outcome.  J Med Assoc Thai. 2003;  86 (5) 436-441
    Search in Google Scholar
  • 41 Muttarak M, Peh W CG, Euathrongchit J et al.. Spectrum of imaging findings in melioidosis.  Br J Radiol. 2009;  82 (978) 514-521
    Search in Google Scholar
  • 42 Cheng A C, Johnson D F. Multiloculated hepatosplenic abscesses.  Clin Infect Dis. 2006;  43 (2) 264-265
    Search in Google Scholar
  • 43 Chubachi A, Miura I, Ohshima A et al.. Risk factors for hepatosplenic abscesses in patients with acute leukemia receiving empiric azole treatment.  Am J Med Sci. 1994;  308 (6) 309-312
    Search in Google Scholar
  • 44 Murray J G, Patel M D, Lee S, Sandhu J S, Feldstein V A. Microabscesses of the liver and spleen in AIDS: detection with 5-MHz sonography.  Radiology. 1995;  197 (3) 723-727
    Search in Google Scholar
  • 45 Takayanagi M, Nagayama R, Komaba S et al.. Hepatosplenic abscess due to candida infection effectively treated by the intraarterial injection of an antimycotic agent using an implanted reservoir.  J Gastroenterol. 2003;  38 (12) 1197-1198
    Search in Google Scholar
  • 46 Wilde C C, Kueh Y K. Case report: tuberculous hepatic and splenic abscess.  Clin Radiol. 1991;  43 (3) 215-216
    Search in Google Scholar
  • 47 Ng W M, Kwan M K, Merican A M. Melioidotic osteomyelitis treated with antibiotic-calcium hydroxyapatite composite: case report with four-year follow-up.  Singapore Med J. 2006;  47 (1) 71-74
    Search in Google Scholar
  • 48 Kosuwon W, Taimglang T, Sirichativapee W, Jeeravipoolvarn P. Melioidotic septic arthritis and its risk factors.  J Bone Joint Surg Am. 2003;  85-A (6) 1058-1061
    Search in Google Scholar

Nuttaya PattamapaspongM.D. 

Department of Radiology, Faculty of Medicine, Chiang Mai University

110 Intavaroros Road, Chiang Mai 50200, Thailand

Email: nuttaya@gmail.com