Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India
Two distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small per...
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The Journal of Infection in Developing Countries
2015-11-01
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| Series: | Journal of Infection in Developing Countries |
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| Online Access: | https://jidc.org/index.php/journal/article/view/6586 |
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| author | Kavitha Saravu Rajagopal Kadavigere Ananthakrishna Barkur Shastry Rohit Pai Chiranjay Mukhopadhyay |
| author_facet | Kavitha Saravu Rajagopal Kadavigere Ananthakrishna Barkur Shastry Rohit Pai Chiranjay Mukhopadhyay |
| author_sort | Kavitha Saravu |
| collection | DOAJ |
| description | Two distinct and potentially deceitful cases of neurologic melioidosis are reported.
Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline.
Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline.
Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis.
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| format | Article |
| id | doaj-art-8e4c51a8f01943a0ac4d859b26aaffb7 |
| institution | Kabale University |
| issn | 1972-2680 |
| language | English |
| publishDate | 2015-11-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-8e4c51a8f01943a0ac4d859b26aaffb72025-08-20T03:52:39ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802015-11-0191110.3855/jidc.6586Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in IndiaKavitha Saravu0Rajagopal Kadavigere1Ananthakrishna Barkur Shastry2Rohit Pai3Chiranjay Mukhopadhyay4Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, IndiaKasturba Medical College, Manipal University, Madhav Nagar, Manipal, IndiaKasturba Medical College, Manipal University, Madhav Nagar, Manipal, IndiaKasturba Medical College, Manipal University, Madhav Nagar, Manipal, IndiaKasturba Medical College, Manipal University, Madhav Nagar, Manipal, IndiaTwo distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline. Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline. Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis. https://jidc.org/index.php/journal/article/view/6586melioidosisBurkholderia infectionneurologic melioidosis |
| spellingShingle | Kavitha Saravu Rajagopal Kadavigere Ananthakrishna Barkur Shastry Rohit Pai Chiranjay Mukhopadhyay Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India Journal of Infection in Developing Countries melioidosis Burkholderia infection neurologic melioidosis |
| title | Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India |
| title_full | Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India |
| title_fullStr | Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India |
| title_full_unstemmed | Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India |
| title_short | Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India |
| title_sort | neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in india |
| topic | melioidosis Burkholderia infection neurologic melioidosis |
| url | https://jidc.org/index.php/journal/article/view/6586 |
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