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Melioidosis, an infection caused by the bacterium Burkholderia pseudomallei, has a wide range of clinical manifestations. Here, we describe rheumatological melioidosis (involving one or more of joint, bone or muscle), and compare features and outcome with patients without rheumatological involvement. A retrospective study of patients with culture-confirmed melioidosis admitted to Sappasithiprasong Hospital, Ubon Ratchathani during 2002 and 2005 identified 679 patients with melioidosis, of whom 98 (14.4%) had rheumatological melioidosis involving joint (n=52), bone (n = 5), or muscle (n = 12), or a combination of these (n=29). Females were over-represented in the rheumatological group, and diabetes and thalassemia were independent risk factors for rheumatological involvement (OR; 2.49 and 9.56, respectively). Patients with rheumatological involvement had a more chronic course, as reflected by a longer fever clearance time (13 vs 7 days, p = 0.06) and hospitalization (22 vs 14 days, p < 0.001), but lower mortality (28% vs 44%, p = 0.005). Patients with signs and symptoms of septic arthritis for longer than 2 weeks were more likely to have extensive infection of adjacent bone and muscle, particularly in diabetic patients. Surgical intervention was associated with a survival benefit, bur not a shortening of the course of infection.

Type

Journal article

Journal

The Southeast Asian journal of tropical medicine and public health

Publication Date

07/2008

Volume

39

Pages

649 - 655

Addresses

Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand. prapith_11@hotmail.com

Keywords

Humans, Burkholderia pseudomallei, Melioidosis, Arthritis, Infectious, Osteomyelitis, Arthritis, Rheumatoid, Diabetes Mellitus, Risk Factors, Retrospective Studies, Adult, Middle Aged, Thailand, Female, Male, Pyomyositis