Cranial Melioidosis Presenting as Osteomyelitis and/or Extra-Axial Abscess: Literature Review

Research output: Contribution to journalReview article

Abstract

Background: Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. Methods: A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. Results: Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60%) were from India. The mean age of patients was 45.5 years (range, 29–74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2–8 weeks) and 5.5 months (range, 3–12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weeks–40 months). Two deaths (10%) were reported, and 1 case of residual frontal abscess had relapse. Conclusions: Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2–3 weeks followed by maintenance phase for 3–6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.

Original languageEnglish
Pages (from-to)67-75
Number of pages9
JournalWorld Neurosurgery
Volume134
DOIs
Publication statusPublished - 02-2020

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Melioidosis
Osteomyelitis
Abscess
Scalp
Central Nervous System
Maintenance
Recurrence
Debridement
Nervous System Diseases
Causality
Nervous System
Headache
India
Fever
Therapeutics
Age Groups
Databases
Pediatrics
Mortality
Infection

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

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title = "Cranial Melioidosis Presenting as Osteomyelitis and/or Extra-Axial Abscess: Literature Review",
abstract = "Background: Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. Methods: A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. Results: Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60{\%}) were from India. The mean age of patients was 45.5 years (range, 29–74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2–8 weeks) and 5.5 months (range, 3–12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weeks–40 months). Two deaths (10{\%}) were reported, and 1 case of residual frontal abscess had relapse. Conclusions: Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2–3 weeks followed by maintenance phase for 3–6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.",
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Cranial Melioidosis Presenting as Osteomyelitis and/or Extra-Axial Abscess : Literature Review. / Prasad, G. Lakshmi.

In: World Neurosurgery, Vol. 134, 02.2020, p. 67-75.

Research output: Contribution to journalReview article

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N2 - Background: Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. Methods: A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. Results: Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60%) were from India. The mean age of patients was 45.5 years (range, 29–74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2–8 weeks) and 5.5 months (range, 3–12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weeks–40 months). Two deaths (10%) were reported, and 1 case of residual frontal abscess had relapse. Conclusions: Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2–3 weeks followed by maintenance phase for 3–6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.

AB - Background: Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. Methods: A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. Results: Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60%) were from India. The mean age of patients was 45.5 years (range, 29–74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2–8 weeks) and 5.5 months (range, 3–12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weeks–40 months). Two deaths (10%) were reported, and 1 case of residual frontal abscess had relapse. Conclusions: Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2–3 weeks followed by maintenance phase for 3–6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.

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