ABSTRACT
The etiological agent of melioidosis is a Gram-negative bacillus Burkholderia pseudomallei. It can virtually affect any organ, but central nervous system (CNS) infection rarely occurs, which ranges from 1 to 5%. It commonly affects adults, with the median age of presentation being 40 years, with a male preponderance. Infection results from inhalation, ingestion, or percutaneous inoculation, with the hematogenous spread of microorganisms to the CNS as the predominant mode of transmission. Diabetes mellitus is the most common risk factor identified. The neurological manifestation can occur due to encephalomyelitis and brain abscess though rarely isolated meningitis, myelitis, or extra-axial abscess can also occur. Fever, headache, unilateral weakness, and cranial nerve deficits are the most prominent presenting feature. Cerebrospinal fluid study shows lympho-mononuclear cells predominantly with high protein and near-normal glucose. Contrast-enhanced MRI is the most sensitive imaging study that shows rim-enhancing patterns to a frank abscess, with the brainstem being the most common site. It requires long-term management with appropriate antibiotics with 20–25% mortality.
