Melioidotic osteomyelitis in northern Australia.

Abstract

Osteomyelitis is a well-recognized manifestation of melioidosis, a significant disease that is endemic in South-East Asia and northern Australia. Diagnosis requires a high degree of clinical suspicion and is dependent on microbiological confirmation; important clues are travel to or residence in an endemic area. Infection often but not always occurs in well-recognized risk groups, especially diabetics and alcoholics. Subacute presentations often mimic other disease processes and patients may not always be clinically septic. Treatment requires surgical drainage in combination with multiple antibiotic therapy, including at least 2 weeks of intravenous ceftazidime and oral therapy continuing for 3-6 months. Non-compliance usually results in relapse. Due to the potential long latency of the disease and the possibility of reactivation, follow-up should probably be life-long. A prospective study of 115 patients presenting with melioidosis between 1989 and 1995 was undertaken. Four patients were found to have osteomyelitis. It is important to be aware of this condition so that early treatment can be initiated.