Brain abscesses caused by Burkholderia pseudomallei

Area of Science:

• Infectious Diseases
• Neurology
• Medical Imaging

Background:

• Melioidosis is a significant human infectious disease caused by Burkholderia pseudomallei, prevalent in tropical regions like Southeast Asia and Northern Australia.
• Prompt recognition and treatment are vital for managing melioidosis, a condition that can lead to severe complications.

Observation:

• A fatal case of melioidosis presented with brain abscesses, with the patient deteriorating despite antibiotic treatment.
• Burkholderia pseudomallei was isolated only after corticosteroid administration, despite in vitro antibiotic sensitivity.
• Magnetic resonance imaging (MRI) demonstrated higher sensitivity than computed tomography (CT) in detecting early brainstem infection.

Findings:

• The case highlights diagnostic challenges, including delayed pathogen isolation and the potential impact of corticosteroid use on diagnosis.
• Characteristic MRI findings, such as extensive T2 hyperintensity with small enhancing lesions, may aid in early melioidosis diagnosis.
• Physicians outside endemic areas need heightened awareness for melioidosis in patients with relevant travel history.

Implications:

• This case underscores the importance of considering melioidosis in the differential diagnosis of brain infections, particularly in patients with travel history to endemic areas.
• Advanced neuroimaging techniques like MRI may offer superior diagnostic capabilities for early-stage melioidosis brain involvement.
• Clinicians should be aware of potential diagnostic delays and the influence of immunosuppressive therapies on pathogen detection in melioidosis.