title: Rheumatological manifestations in patients with melioidosis.
abstract: 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.
authors.affiliation: Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand. prapith_11@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Teparrakkul
authors.forename: J J
authors.initials: JJ
authors.lastname: Tsai
authors.forename: W
authors.initials: W
authors.lastname: Chierakul
authors.forename: J F
authors.initials: JF
authors.lastname: Gerstenmaier
authors.forename: T
authors.initials: T
authors.lastname: Wacharaprechasgu
authors.forename: W
authors.initials: W
authors.lastname: Piyaphanee
authors.forename: D
authors.initials: D
authors.lastname: Limmathurotsakul
authors.forename: W
authors.initials: W
authors.lastname: Chaowagul
authors.forename: N P
authors.initials: NP
authors.lastname: Day
authors.forename: S J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000328:Adult; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000382:microbiology; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000382:microbiology*; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D003920:Diabetes Mellitus / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000382:microbiology; D052880:Pyomyositis / Q000000981:diagnostic imaging / Q000382:microbiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand