Septic arthritis caused by Burkholderia pseudomallei: case report and review of the literature.

We describe a case of septic arthritis and bacteremia caused by Burkholderia pseudomallei, a bacterium that is endemic in East Asia and northern Australia. We believe that dissemination occurred in our patient after surgical excision of a pulmonary nodule. Bacteremic melioidosis can present with musculoskeletal involvement in 2-10% of patients, but septic arthritis is uncommon. A review of the literature shows a total of 66 patients reported with septic arthritis caused by this organism. Patients with septic arthritis caused by Burkholderia pseudomallei were likely to have diabetes mellitus, and the knee is the joint most frequently affected by this organism. Recommended initial treatment consists of ceftazidime, alone or in combination with trimethoprim/sulfamethoxazole, high dose imipenem/cilastatin, or high dose cefoperazone/sulbactam. This is followed by a 12-20 week course of oral therapy (based on susceptibilities) to eradicate the organism. Most patients with subacute or latent disease do well after full antibiotic treatment, but relapses are common if full treatment is not given. Awareness of this disease is important even in areas outside of Asia given the increasing frequency of international travel and the growing likelihood of imported cases, along with an aging population of Vietnam veterans and immigrants.