A Case Report on Musculoskeletal Melioidosis

Suman Kundu; Sonia Deb; Tanvi Mallick; Swagata Ganguly Bhattacharjee

doi:10.55489/njmr.150220251083

Authors

Suman Kundu Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, India https://orcid.org/0000-0001-8861-7061
Sonia Deb Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, India https://orcid.org/0009-0002-2924-5442
Tanvi Mallick Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, India https://orcid.org/0009-0006-9041-5163
Swagata Ganguly Bhattacharjee Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, India https://orcid.org/0000-0002-5978-778X

DOI:

https://doi.org/10.55489/njmr.150220251083

Keywords:

Melioidosis, Burkholderia pseudomallei, Endemic, Diagnosis delay, Clinical microbiology

Abstract

Melioidosis, caused by Burkholderia pseudomallei, is an underdiagnosed infection in India with a high case fatality rate if untreated. We report a case of a 59-year-old diabetic male farmer from West Bengal who presented with fever and respiratory distress. Initial empirical therapy with cefoperazone-sulbactam failed to improve his condition. Subsequently, he developed acute pain and swelling in the left shoulder. Imaging revealed osteomyelitis with intraarticular and periarticular abscesses. Surgical debridement and culture studies confirmed B. pseudomallei, identified using Ashdown’s medium, Gram staining, biochemical tests, and automated Vitek 2 analysis. The organism exhibited resistance to ceftazidime but was susceptible to meropenem and doxycycline. Despite initiation of targeted therapy, the patient took discharge against medical advice, preventing further outcome assessment. This case highlights the challenges of diagnosing melioidosis, particularly in rural settings where it mimics other tropical infections. Early suspicion, appropriate microbiological workup, and prompt initiation of effective antimicrobial therapy are crucial for improved outcomes. Greater clinician awareness and expanded diagnostic capacity are needed to prevent missed diagnoses and reduce mortality in endemic regions.

References

DR S. VENKATESH. National Centre for Disease Control. 2019. CD Alert - MELIOIDOSIS.

Mukhopadhyay C, Kaestli M, Vandana KE, Sushma K, Mayo M, Richardson L, et al. Molecular Characterization of Clinical Burkholderia pseudomallei Isolates from India. The American Society of Tropical Medicine and Hygiene. 2011 Jul 1;85(1):121-3. DOI: https://doi.org/10.4269/ajtmh.2011.11-0166 PMid:21734136 PMCid:PMC3122355 DOI: https://doi.org/10.4269/ajtmh.2011.11-0166

Procop GW, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger PC, et al. Koneman's color atlas and textbook of diagnostic microbiology. Seventh edition. Philadelphia: Wolters Kluwer Health; 2017. Chapter 7, The Nonfermentative Gram-Negative Bacilli; p.856.

Schweizer HP. Mechanisms of Antibiotic Resistance in Burkholderia Pseudomallei: Implications for Treatment of Melioidosis. Future Microbiology. 2012 Dec 12;7(12):1389-99. DOI: https://doi.org/10.2217/fmb.12.116 PMid:23231488 PMCid:PMC3568953 DOI: https://doi.org/10.2217/fmb.12.116

Liu L, Gee J, Blaney D. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). 2023. Melioidosis CDC Yellow Book 2024.

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, et al. Melioidosis. Nature Reviews Disease Primers. 2018 Feb 1;4(1):17107. DOI: https://doi.org/10.1038/nrdp.2017.107 PMid:29388572 PMCid:PMC6456913 DOI: https://doi.org/10.1038/nrdp.2017.107

Wang YS, Wong CH, Kurup A. Cutaneous Melioidosis and Necrotizing Fasciitis Caused by Burkholderia pseudomallei. Emerging Infectious Diseases. 2003 Nov;9(11):1484-5. DOI: https://doi.org/10.3201/eid0911.030370 PMid:14725266 PMCid:PMC3035558 DOI: https://doi.org/10.3201/eid0911.030370

Chua MWJ. The Great Mimicker or the Great Masquerader? The American Journal of Medicine. 2022 Feb;135(2):e27-30. DOI: https://doi.org/10.1016/j.amjmed.2021.08.040 PMid:34655534 DOI: https://doi.org/10.1016/j.amjmed.2021.08.040

Hoffmaster AR, AuCoin D, Baccam P, Baggett HC, Baird R, Bhengsri S, et al. Melioidosis Diagnostic Workshop, 20131. Emerging Infectious Diseases. 2015 Feb;21(2):e141045. DOI: https://doi.org/10.3201/eid2102.141045 PMid:25626057 PMCid:PMC4313648 DOI: https://doi.org/10.3201/eid2102.141045

Kingsley PV, Arunkumar G, Tipre M, Leader M, Sathiakumar N. Pitfalls and optimal approaches to diagnose melioidosis. Asian Pacific Journal of Tropical Medicine. 2016 Jun;9(6):515-24. DOI: https://doi.org/10.1016/j.apjtm.2016.04.003 PMid:27262061 DOI: https://doi.org/10.1016/j.apjtm.2016.04.003

Ashdown LR. An improved screening technique for isolation of Pseudomonas pseudomallei from clinical specimens. Pathology. 1979 Jan 1;11(2):293-7. DOI: https://doi.org/10.3109/00313027909061954 PMid:460953 DOI: https://doi.org/10.3109/00313027909061954

K. Hodgson, C. Engler, B. Govan, N. Ketheesan, R. Norton. Comparison of routine bench and molecular diagnostic methods in identification of Burkholderia pseudomallei. J Clin Microbiol, 47 (2009), pp. 1578-1580. DOI: https://doi.org/10.1128/JCM.02507-08 PMid:19279182 PMCid:PMC2681847 DOI: https://doi.org/10.1128/JCM.02507-08

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twentieth informational supplement. Approved standard M100-S24. Clinical and Laboratory Standards Institute, Wayne, PA (2014)

Breakpoint Tables for Interpretation of MICs and Zone Diameters Version 13.1. Sweden: European Committee on Antimicrobial Susceptibility Testing; [ Jan; 2025]. 2023. European Committee on Antimicrobial Susceptibility Testing. EUCAST clinical breakpoint tables for interpretation of MICs and zone diameters, version 13.1.

Zheng W, Kuang S, Zhong C, Zhou J, Long W, Xiao S, et al. Risk Factors for Melioidosis Mortality and Epidemics: A Multicentre, 10-Year Retrospective Cohort Study in Northern Hainan. Infectious Diseases and Therapy. 2023 Mar 17;12(3):951-64. DOI: https://doi.org/10.1007/s40121-023-00768-3 PMid:36800150 PMCid:PMC9936936 DOI: https://doi.org/10.1007/s40121-023-00768-3

Currie BJ, Jacups SP. Intensity of Rainfall and Severity of Melioidosis, Australia. Emerging Infectious Diseases. 2003 Dec;9(12):1538-42. DOI: https://doi.org/10.3201/eid0912.020750 PMid:14720392 PMCid:PMC3034332 DOI: https://doi.org/10.3201/eid0912.020750

Mukhopadhyay C, Shaw T, Varghese GM, Dance DAB. Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan). Tropical Medicine and Infectious Disease. 2018 May 22;3(2):51. DOI: https://doi.org/10.3390/tropicalmed3020051 PMid:30274447 PMCid:PMC6073985 DOI: https://doi.org/10.3390/tropicalmed3020051

Mohapatra PR, Mishra B. Burden of melioidosis in India and South Asia: Challenges and ways forward. The Lancet Regional Health - Southeast Asia. 2022 Jul; 2:100004. DOI: https://doi.org/10.1016/j.lansea.2022.03.004 PMid:37383295 PMCid:PMC10306050 DOI: https://doi.org/10.1016/j.lansea.2022.03.004

Raja NS, Scarsbrook C. Burkholderia pseudomallei causing one and joint infections: A clinical update. Infect Dis Ther. 2016;5(1):17-29. DOI: https://doi.org/10.1007/s40121-015-0098-2 PMid:26728713 PMCid:PMC4811834 DOI: https://doi.org/10.1007/s40121-015-0098-2

Khiangte HL, Robinson Vimala L, Veeraraghavan B, Yesudhason BL, Karuppusami R. Can the imaging manifestations of melioidosis prognosticate the clinical outcome? A 6-year retrospective study. Insights Imaging. 2019;10(1):17. DOI: https://doi.org/10.1186/s13244-019-0708-8 PMid:30758675 PMCid:PMC6375099 DOI: https://doi.org/10.1186/s13244-019-0708-8

Yadav V, Pawar A, Meena M, Khadanga S, Gupta A, Dandasena TP, et al. Melioidosis as a Mystique Infection: A Study From Central India. Cureus. 2023 Aug;15(8):e43439. DOI: https://doi.org/10.7759/cureus.43439 DOI: https://doi.org/10.7759/cureus.43439