Melioidosis with a subdural collection – a case report
| Autor: | P. M. Y. I. Tilakaratna, U. K. Ranawaka, F. H. D. S. Silva, S. F. Jayamanne, H. L. P. Amarasena |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 0301 basic medicine Pediatrics medicine.medical_specialty Melioidosis Burkholderia pseudomallei Constitutional symptoms 030106 microbiology Case Report Physical examination Subdural Space Asymptomatic lcsh:Infectious and parasitic diseases Diabetes Complications 03 medical and health sciences 0302 clinical medicine Trimethoprim Sulfamethoxazole Drug Combination medicine Humans Blood culture lcsh:RC109-216 030212 general & internal medicine Abscess Sri Lanka Brain Diseases medicine.diagnostic_test biology business.industry Brain Meropenem medicine.disease biology.organism_classification Magnetic Resonance Imaging Anti-Bacterial Agents Infectious Diseases Diabetes Mellitus Type 2 Subdural collection Doxycycline Gentamicins medicine.symptom Headaches business |
| Zdroj: | BMC Infectious Diseases, Vol 19, Iss 1, Pp 1-7 (2019) BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. Case presentation A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. Conclusions Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic. |
| Databáze: | OpenAIRE |
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