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Case Report: Isolated Central Nervous System Melioidosis from a Non-Endemic Area

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  • 1 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India;
  • 2 Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India;
  • 3 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;
  • 4 Department of Microbiology, All India Institue of Medical Sciences, New Delhi, India;
  • 5 Department of NeuroPathology, All India Institute of Medical Sciences, New Delhi, India

ABSTRACT

Central nervous system (CNS) melioidosis is a rare neurological infectious disease which carries a high mortality. We describe a previously healthy middle-aged female, who presented to us with left-sided hemiparesis and was on antitubercular therapy from a previous presumed diagnosis of CNS tuberculoma. Non-characteristic imaging picture, multiple negative body fluid cultures, and positive Cerebrospinal fluid galactomannan led to a further delay in diagnosis. Gram stain of the tissue obtained from brain biopsy revealed Gram-negative rods in “safety pin” appearance. By picking up the colonies that appeared on blood agar and MacConkey agar, the identification of the clinical isolates was performed using VITEK® matrix (BioMérieux, Marcy-L’Etoile, France)-assisted laser desorption ionization time-of-flight mass spectrometry (VITEK MALDI TOF MS database version 3.2) which revealed Burkholderia pseudomallei. After the institution of appropriate treatment, she survived but with significant morbidity. A high index of suspicion should be kept for such previously healthy individuals belonging to non-endemic areas, where presentation is suspicious of an infective etiology, but not improving despite appropriate therapy. This may help in early recognition and institution of recommended treatment so that mortality can be avoided.

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Author Notes

Address correspondence to Madakasira Vasantha Padma Srivastava, Department of Neurology, C. N. Centre, All India Institute of Medical Sciences, Rm. No. 702, New Delhi 110029, India. E-mail: vasanthapadma123@gmail.com

Authors’ addresses: Biswamohan Mishra, Venugopalan Y. Vishnu, Rohit Bhatia, Mamta Bhushan Singh, Roopa Rajan, Anu Gupta, and Madakasira Vasantha Padma Srivastava, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India, E-mails: biswamohan26@gmail.com, vishnuvy16@yahoo.com, rohitbhatia71@yahoo.com, mbsneuro@gmail.com, rooparajan@aiims.edu, doctoranugupta1@gmail.com, and vasanthapadma123@gmail.com. Ajay Garg, Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India, E-mail: drajaygarg@gmail.com. Ramesh Sharanappa Doddamani and Parul Singh, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India, E-mails: drsdramesh@gmail.com and parul5fiore@gmail.com. Mehar Chand Sharma, Department of NeuroPathology, All India Institute of Medical Sciences, New Delhi, India, E-mail: sharmamehar@yahoo.co.in.

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