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 was confirmed later through blood or pus culture. Two patients achieved complete recovery, one had partial recovery, and one patient succumbed to the illness. Our case series is unique in that it presents four cases of neuromelioidosis who presented over a one year period to our urban tertiary care unit. All four cases presented with short history and rapidly progressing neurological disorders.Though the diagnosis was not initially considered , features like endemicity and atypical features like fever and facial pain as well as microbial cultures led to the diagnosis. This report aims to raise awareness among the medical community regarding the neurological presentations of melioidosis.
Nambiar et al. (Sun,) studied this question.