Melioidosis presenting as septic arthritis in hip joint of a 60-year old patient: Findings from a hospital-based surveillance in Bangladesh.

Melioidosis is a fatal bacterial infection caused by a soil-borne bacterium Burkholderia pseudomallei. Pneumonia, localized abscess and acute septicemia are the most common clinical presentations for melioidosis. Septic arthritis is relatively uncommon clinical manifestation and may cause severe infection. Here, we report a melioidosis case of a 60-year old diabetic male presenting with fever and acute hip pain. B. pseudomallei was isolated from blood culture and it was sensitive to meropenem, amoxicillin-clavulanic acid, cotrimoxazole, ceftazidime and doxycycline. The genome sequence from the clinical isolate obtained from this patient clusters with other Bangladeshi strains and it is within the major clade of East and Southeast Asia strains. The patient received parental meropenem for four weeks followed by six months of oral cotrimoxazole and doxycycline. We followed up the patients every three months over the past seven months. After seven months of oral antibiotic therapy, the patient fully recovered without feeling pain in hip joint and no further complications. His blood culture was tested negative after seven months. The findings of the case report are valuable for raising clinical suspicion and prompting laboratory testing to detect melioidosis. The report also detailed the disease progression and the response to antibiotic therapy.