Cranial melioidosis presenting as osteomyelitis and/or extra-axial abscess: Literature review

Prasad, Lakshmi G (2020) Cranial melioidosis presenting as osteomyelitis and/or extra-axial abscess: Literature review. World Neurosurgery, 134. pp. 67-75. ISSN 1878-8750

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BACKGROUND: Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. METHODS: A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. RESULTS: Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60%) were from India. The mean age of patients was 45.5 years (range, 29e74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2e8 weeks) and 5.5 months (range, 3e12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weekse40 months). Two deaths (10%) were reported, and 1 case of residual frontal abscess had relapse. CONCLUSIONS: Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2e3 weeks followed by maintenance phase for 3e6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.

Item Type: Article
Uncontrolled Keywords: Burkholderia pseudomallei; cerebral melioidosis; cranial melioidosis; India; melioidosis; osteomyelitis.
Subjects: Medicine > KMC Manipal > Neuro Surgery
Depositing User: KMC Library
Date Deposited: 14 Sep 2020 11:49
Last Modified: 14 Sep 2020 11:49

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