Aim. Melioidosis is a significant public health problem in endemic regions such as India. Lack of awareness, predominant empiric antibiotic use reducing culture yields, morphotypic variability of cultures and frequent misidentification by automated blood culture systems, pose myriad challenges in diagnosis and treatment. Through this series, we present our experience of Hematogenous Osteomyelitis with Burkholderia pseudomallei. Method. This was a single centre, retrospective, observational study performed at a tertiary case hospital in Mumbai, India from June 2011 to June 2021. Results. The study comprised of 7 cases (6:1, M: F). Mean age was 53.7 years (5 to 75). All had an underlying co- morbidity or were immunosuppressed. 3 patients were misidentified by automated systems prior to presentation (e coli, burkholderia cepacieae, acinetobacter). Most common site of infection was femur (n= 3), followed by tibia and foot and ankle (n= 2, each). One had disseminated meliodosis involving the spleen, lymph nodes, pulmonary) in addition to involvement of bilateral feet and ankles. B. pseudomallei was identified in all following surgical debridement at our institute. Each patient underwent mean 2 procedures. 3 needed local rotation flap surgeries for wound cover. All were treated with ceftazidime along with trimethoprim- sulfamethoxazole (TMP- SMX) during the 6 week induction phase. TMP- SMX was continued for a further 6 months in the consolidation phase. All patients had infection remission at a mean 19.3 months follow up. There were no mortalities in our series. Conclusions. Clinically Burkholderia infections mimic other pyogenic infections, Gram-negative sepsis, tuberculosis and has been referred to as the “remarkable imitator” and the “mimicker of maladies”. Diabetes and alcoholism are risk factors. The need for diagnosing this entity is due to the fact that the septicemic form has a mortality rate that exceeds 90%. Melioidosis is frequently misidentified. A high clinical suspicion, communication with microbiologist, knowledge about the biochemical, cultural and phenotypic susceptibility patterns may help in optimising diagnosis. Adequate debridement coupled with targeted prolonged antibiotics help achieve good outcomes

Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis.

We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse.

We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048).

More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

Cite this article: Bone Joint J 2015;97-B:277–82.

Melioidosis is an uncommon infection caused by a Gram-negative bacillus, Pseudomonas pseudomallei. Only a few case reports of orthopaedic infection have been published in English, and most were of isolated septic arthritis or secondary to melioidosis of another organ. We have reviewed ten patients with localised melioidotic osteomyelitis; six had underlying conditions. We discuss the importance of obtaining a bacteriological diagnosis, and of surgical debridement as well as appropriate antibiotic therapy