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Melioidosis with a subdural collection – a case report

BACKGROUND: Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioido...

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Autores principales: Amarasena, H. L. P., Silva, F. H. D. S., Tilakaratna, P. M. Y. I., Jayamanne, S. F., Ranawaka, U. K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373098/
https://www.ncbi.nlm.nih.gov/pubmed/30755178
http://dx.doi.org/10.1186/s12879-019-3782-0
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author Amarasena, H. L. P.
Silva, F. H. D. S.
Tilakaratna, P. M. Y. I.
Jayamanne, S. F.
Ranawaka, U. K.
author_facet Amarasena, H. L. P.
Silva, F. H. D. S.
Tilakaratna, P. M. Y. I.
Jayamanne, S. F.
Ranawaka, U. K.
author_sort Amarasena, H. L. P.
collection PubMed
description BACKGROUND: Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.
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spelling pubmed-63730982019-02-25 Melioidosis with a subdural collection – a case report Amarasena, H. L. P. Silva, F. H. D. S. Tilakaratna, P. M. Y. I. Jayamanne, S. F. Ranawaka, U. K. BMC Infect Dis Case Report BACKGROUND: Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic. BioMed Central 2019-02-12 /pmc/articles/PMC6373098/ /pubmed/30755178 http://dx.doi.org/10.1186/s12879-019-3782-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Amarasena, H. L. P.
Silva, F. H. D. S.
Tilakaratna, P. M. Y. I.
Jayamanne, S. F.
Ranawaka, U. K.
Melioidosis with a subdural collection – a case report
title Melioidosis with a subdural collection – a case report
title_full Melioidosis with a subdural collection – a case report
title_fullStr Melioidosis with a subdural collection – a case report
title_full_unstemmed Melioidosis with a subdural collection – a case report
title_short Melioidosis with a subdural collection – a case report
title_sort melioidosis with a subdural collection – a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373098/
https://www.ncbi.nlm.nih.gov/pubmed/30755178
http://dx.doi.org/10.1186/s12879-019-3782-0
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