Neurological melioidosis in Norway presenting with a cerebral abscess

Abstract

Neurological melioidosis is a rare condition, as less than 30 cases have been reported in the last 50 years. We present a case of neurological melioidosis, presenting with a cerebral abscess in a returning traveler from an endemic area. While traveling in Cambodia on holiday, the patient was admitted to local hospital for pneumonia. Her condition improved after antimicrobial treatment, and she returned to Norway when discharged. The patient had several contacts with the health care system after returning to Norway, due to recurrent fever and deterioration. Short-term antimicrobial treatment was given with temporary improvement in her condition. Eventually she developed stroke-like symptoms, and a cerebral abscess was found. Cultures from the abscess were positive for Burkholderia pseudomallei and the treatment was adjusted accordingly.

Intracranial Manifestation of Melioidosis: A Case Report and Long-Term Follow-Up

“…Intracranial melioidosis is a very rare finding in Scandinavia and the western hemisphere with only a few cases previously diagnosed in Europe [ 6 , 8 , 9 ]. The initial investigations with CT and MRI scans in the present case pointed towards chronic epidural hematoma, itself an atypical neurosurgical condition [ 10 ].…”

Multi-systemic melioidosis: a clinical, neurological, and radiological case study from Hainan Province, China

“…Other forms of infection include prostatic abscess, parotitis, skin and soft tissue infections, and encephalomyelitis. CNS melioidosis has been increasingly reported in recent years [7], and neurological melioidosis has a high mortality rate of approximately 25% [8, 9]. It should require more attention.…”

“…Acute disseminated infection is characterised by multiple lung nodules or multilobar consolidation with the subsequent formation and rupture of cavities, leading to pneumothorax or bronchopleural fistula. Subacute or chronic localised infection follows an insidious course and manifests as lobar, segmental consolidation, patchy opacities, or migrating opacities [12].…”

Human melioidosis reported by ProMED

“… 8,9 It causes a wide spectrum of clinical manifestations 10 that includes asymptomatic seroconversion, pneumonia, atypical forms with neurological involvement, and severe forms causing septicaemia and death. 8,11 Alcohol consumption, diabetes mellitus, and chronic kidney disease are risk factors for more severe disease. 1,11 B. pseudomallei infection requires prolonged antibiotic therapy to achieve the eradication of the organism and prevent relapses.…”

“… 8,11 Alcohol consumption, diabetes mellitus, and chronic kidney disease are risk factors for more severe disease. 1,11 B. pseudomallei infection requires prolonged antibiotic therapy to achieve the eradication of the organism and prevent relapses. 12 …”