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Published on: February 24, 2023

Cerebral melioidosis in Singapore: a review of five cases

D R Chadwick1, B Ang, Y Y Sitoh

  • 1Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore. david.chadwick@addenbrookes.nhs.uk

Transactions of the Royal Society of Tropical Medicine and Hygiene
|April 3, 2002
PubMed

Insights

Melioidosis can cause brain abscesses, a serious neurological complication. Prompt surgical drainage and prolonged intravenous antibiotics, such as ceftazidime or imipenem, led to survival in all reported cases of cerebral melioidosis.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Medical Microbiology

Background:

  • Neurological melioidosis, particularly cerebral abscesses caused by Burkholderia pseudomallei, presents a significant clinical challenge.
  • Optimal antibiotic regimens for neurological melioidosis remain undefined, with intravenous combinations often employed initially.

Observation:

  • This study details five cases of cerebral melioidosis with brain abscesses in Singapore (1997-2000).
  • Four of these cases exhibited evidence of disseminated infection.
  • Sinusitis was an incidental finding on CT/MRI in 4 out of 5 patients, a previously undescribed association.

Findings:

  • Despite severe neurological deficits and low Glasgow Coma Scale scores in some patients, all five survived.
  • Treatment involved surgical drainage combined with prolonged intravenous ceftazidime or imipenem.
  • Only two patients experienced residual neurological impairment post-treatment.

Implications:

  • Aggressive management including surgical intervention and appropriate intravenous antibiotics can lead to favorable outcomes in cerebral melioidosis.
  • The association between cerebral melioidosis and sinusitis warrants further investigation.
  • This case series highlights the importance of considering melioidosis in patients with brain abscesses, especially in endemic regions.

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