title: Osteomyelitis and septic arthritis from infection with Burkholderia pseudomallei: A 20-year prospective melioidosis study from northern Australia.
abstract: BACKGROUND
  The gram-negative organism, Burkholderia pseudomallei, is responsible for the disease melioidosis. Septic arthritis and osteomyelitis due to B. pseudomallei are rare but recognised presentations of the disease.
  
  
  METHODS
  A prospective database of all cases of melioidosis in the Northern Territory of Australia has been kept since October 1989. Entries to April 2009 were reviewed and cases involving bone and/or joint were investigated. We also present in detail the case reports of 3 presentations of bone and joint melioidosis.
  
  
  RESULTS
  There were 536 presentations of melioidosis during the 20-year study period. Amongst these, there were 13 patients with primary septic arthritis and 7 cases of primary osteomyelitis. Septic arthritis and osteomyelitis were secondary to primary melioidosis elsewhere in 14 and 7 patients respectively. Melioidosis patients with bone/joint involvement were more likely to be Indigenous (p = 0.006) and female (p = 0.023) compared to patients with other presentations of disease.
  
  
  CONCLUSIONS
  Timely microbiological diagnosis and prompt treatment of melioidosis involving bone and/or joint with appropriate intravenous antibiotics is important, as is adequate surgical drainage and debridement where indicated. A subsequent protracted course of antibiotic eradication therapy is important to avoid relapse of disease.
authors.affiliation: Department of Orthopaedics and Trauma, Royal Darwin Hospital, Casuarina, NT 0811, Australia.
authors.forename: Levi P
authors.initials: LP
authors.lastname: Morse
authors.affiliation: Department of Orthopaedics and Trauma, Royal Darwin Hospital, Casuarina, NT 0811, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics and Trauma, Royal Darwin Hospital, Casuarina, NT 0811, Australia.
authors.forename: Janak
authors.initials: J
authors.lastname: Mehta
authors.affiliation: Menzies School of Health Research, Casuarina, NT 0811, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Ward
authors.affiliation: Menzies School of Health Research, Casuarina, NT 0811, Australia.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Department of Orthopaedics and Trauma, Royal Darwin Hospital, Casuarina, NT 0811, Australia ; Menzies School of Health Research, Casuarina, NT 0811, Australia.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
keywords: Bone; Infection; Melioidosis; Osteomyelitis; Septic arthritis