Variable Presentation of Neurological Melioidosis in Northeast Thailand

Direk Limmathurotsakul Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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Wipada Chaowagul Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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Prawatwong Wongsrikaew Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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Arhtitpong Narmwong Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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Nicholas P. Day Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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Sharon J. Peacock Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Neurosurgery, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

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We describe three instructive cases of neurologic melioidosis that demonstrate the variable nature of clinical manifestations and disease pathology. The appropriate duration and choice of parenteral and oral antimicrobial therapy for neurologic melioidosis are also discussed.

Author Notes

  • 1

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    Chierakul W, Anunnatsiri S, Short JM, Maharjan B, Mootsikapun P, Simpson AJ, Limmathurotsakul D, Cheng AC, Stepniewska K, Newton PN, Chaowagul W, White NJ, Peacock SJ, Day NP, Chetchotisakd P, 2005. Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim–sulfamethoxazole for the treatment of severe melioidosis. Clin Infect Dis 41 :1105–1113.

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    Limmathurotsakul D, Chaowagul W, Chierakul W, Stepniewska K, Maharjan B, Wuthiekanun V, White NJ, Day NP, Peacock SJ, 2006. Risk factors for recurrent melioidosis in northeast Thailand. Clin Infect Dis 43 :979–986.

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  • 15

    Dance DA, Wuthiekanun V, Chaowagul W, White NJ, 1989. The antimicrobial susceptibility of Pseudomonas pseudomallei. Emergence of resistance in vitro and during treatment. J Antimicrob Chemother 24 :295–309.

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