Melioidosis of the extremities in Brunei Darussalam

Introduction: Melioidosis caused by Burkholderia pseudomallei is an infectious disease endemic to Southeast Asia and northern Australia. It has a broad spectrum of clinical manifestations and high mortality, and can mimic other infectious diseases. The aim of this study was to review cases of melioidosis of the extremities in Brunei Darussalam. Methods: Culture-positive cases for Burkholderia pseudomallei in Raja Isteri Pengiran Anak Saleha Hospital were identified from records in the Microbiology Department. The case notes were reviewed to identify patients who were treated for problems affecting the extremities. 14 (13 males and one female) out of 48 patients were identified. Results: The median age of the patients was 45 (range 14-55) years. Septicaemia was the most common presenting feature in 11 patients. Multisystem involvement was noted in eight patients, diabetes mellitus in nine patients and other risk factors in two patients. Blood culture was positive in ten patients and pus culture in 11 patients. The presentations noted were cellulitis of the limbs, abscess, osteomyelitis (three patients each) and septic arthritis (five patients). Orthopaedic intervention (joint washout/incision and drainage/curettage) was required in 11 patients. The median hospital stay was 27.5 (range 13-63) days; two patients required admission to intensive care. No mortality was reported. Conclusion: Melioidosis of the extremities is not uncommon in Brunei Darussalam. It is associated with significant morbidity, and a large number of patients require surgical intervention. Thus, a high index of suspicion is required for early diagnosis and institution of appropriate antibiotic therapy.