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Neuromelioidosis causing rapidly progressing neurological syndromes mimicking stroke and demyelination: Insights from
Sindhu V Nambiar1, Thomas Mathew2, Vimal Chacko Mondy3
1Department of Neurology, Manipal Hospitals, 9 th block jayanagar, Bengaluru, 560041, Karnataka, India.
Abstract:
Melioidosis (Whitmores disease) is caused by Burkholderia pseudomallei, a Gram-negative saprophytic bacterium. In addition to systemic involvement, this neurotropic pathogen can invade the meninges, cranial nerves, brain, and spinal cord, resulting in diverse neurological manifestations. We describe four cases of neuromelioidosis encountered at our urban tertiary institute over a one-year period. All presented with rapidly progressive neurological symptoms mimicking stroke and acute disseminated encephalomyelitis (ADEM). The case series included three males and one female, aged between 32 and 65 years. Two were farmers, and three had diabetes mellitus. The diagnosis was not initially suspected and features like endemicuty and atypical features like fever, facial pain and ulcer led to suspicion of an alternative diagnosis which was confirmed later through blood or pus culture. Two patients achieved complete recovery, one had partial recovery, and one patient succumbed to the illness. This report aims to raise awareness among the medical community regarding the neurological presentations of melioidosis. Also, with recent increase in travel across the world , neuromelioidosis may be considered even in nonendemic areas in the appropriate clinical setting.
Insights
Melioidosis, caused by Burkholderia pseudomallei, can lead to severe neurological issues mimicking stroke. Early suspicion and microbial cultures are crucial for diagnosing this rare but serious neurotropic infection.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a Gram-negative bacterium with neurotropic potential.
- This pathogen can cause diverse neurological manifestations by invading the central nervous system.
Purpose of the Study:
- To describe four unique cases of neuro melioidosis presenting with rapidly progressive neurological symptoms.
- To raise awareness among clinicians about the varied neurological presentations of melioidosis.
Main Methods:
- Retrospective case series of four patients diagnosed with neuro melioidosis over one year.
- Clinical data collection including demographics, symptoms, risk factors, and outcomes.
- Diagnosis confirmed via blood or pus cultures.
Main Results:
- Four patients (3 male, 1 female; aged 32-65) presented with rapid neurological decline mimicking stroke or ADEM.
- Two patients were farmers, and three had diabetes mellitus.
- Two patients recovered fully, one partially, and one died.
Conclusions:
- Neuro melioidosis can present with acute, severe neurological symptoms that may be misdiagnosed.
- Endemicity, atypical symptoms (fever, facial pain), and microbial cultures are key to diagnosis.
- Increased clinical awareness is vital for timely diagnosis and management of neuro melioidosis.
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