Cranial melioidosis presenting as a mass lesion or osteomyelitis

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Object

Melioidosis is caused by Burkholderia pseudomallei and causes multiple abscesses in different organs of the body. Cranial melioidosis, although uncommon, is sometimes confused with tuberculosis and is therefore underecognized. The authors report on 6 cases of cranial infections caused by Burkholderia pseudomalleii, presenting as mass lesions or cranial osteomyelitis, and review the literature.

Methods

The authors performed a retrospective review of the records of patients with cranial melioidosis treated at their institution between 1998 and 2005 to determine the presentation, management, and outcome of patients with this infection.

Results

Of the 6 patients diagnosed with cranial melioidosis during this period, 4 had brain abscesses and 2 had cranial osteomyelitis. All patients were treated surgically, and a diagnosis was made on the basis of histopathological studies. All patients were started on antibiotic therapy following surgery and this was continued for 6 months. One patient died soon after stereotactic aspiration of a brain abscess, and the other 5 patients had good outcomes.

Conclusions

Cranial melioidosis is probably more prevalent than has been previously reported. A high index of suspicion, early diagnosis, initiation of appropriate antibiotic therapy and treatment for an adequate period are essential for assuring good outcome in patients with cranial melioidosis. The authors recommend surgery followed by intravenous ceftazidime treatment for 6 weeks and oral cotrimoxazole for 6 months thereafter in patients with cranial melioidosis.

Abbreviations used in this paper: CT = computed tomography; MIC = minimum inhibitory concentration; MR = magnetic resonance.

Article Information

Address correspondence to: Vedantam Rajshekhar, M.Ch., Department of Neurological Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India. email: rajshekhar@cmcvellore.ac.in.

© AANS, except where prohibited by US copyright law.

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    Case 6. A: Axial Gd-enhanced T1-weighted MR image of the brain showing a conglomerate of ring enhancing lesions in the left frontoparietal region. B: Coronal T1-weighted, Gd-enhanced image of brain showing a separate small enhancing lesion in the corpus callosum. C: Contrast-enhanced CT scan of the brain obtained at the 8-month follow-up examination demonstrating volume loss and mild cortical enhancement in the left frontal lobe.

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