title: Cranial melioidosis presenting as a mass lesion or osteomyelitis.
abstract: OBJECTIVE
  Melioidosis is caused by Burkholderia pseudomallei and causes multiple abscesses in different organs of the body. Cranial melioidosis, although uncommon, is sometimes confused with tuberculosis and is therefore under-recognized. The authors report on 6 cases of cranial infections caused by Burkholderia pseudomallei, presenting as mass lesions or cranial osteomyelitis, and review the literature.
  
  
  METHODS
  The authors performed a retrospective review of the records of patients with cranial melioidosis treated at their institution between 1998 and 2005 to determine the presentation, management, and outcome of patients with this infection.
  
  
  RESULTS
  Of the 6 patients diagnosed with cranial melioidosis during this period, 4 had brain abscesses and 2 had cranial osteomyelitis. All patients were treated surgically, and a diagnosis was made on the basis of histopathological studies. All patients were started on antibiotic therapy following surgery and this was continued for 6 months. One patient died soon after stereotactic aspiration of a brain abscess, and the other 5 patients had good outcomes.
  
  
  CONCLUSIONS
  Cranial melioidosis is probably more prevalent than has been previously reported. A high index of suspicion, early diagnosis, initiation of appropriate antibiotic therapy and treatment for an adequate period are essential for assuring good outcome in patients with cranial melioidosis. The authors recommend surgery followed by intravenous ceftazidime treatment for 6 weeks and oral cotrimoxazole for 6 months thereafter in patients with cranial melioidosis.
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: G Samson Sujit
authors.initials: GS
authors.lastname: Kumar
authors.forename: Promila Mohan
authors.initials: PM
authors.lastname: Raj
authors.forename: Geeta
authors.initials: G
authors.lastname: Chacko
authors.forename: Mukkai K
authors.initials: MK
authors.lastname: Lalitha
authors.forename: Ari G
authors.initials: AG
authors.lastname: Chacko
authors.forename: Vedantam
authors.initials: V
authors.lastname: Rajshekhar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000601:surgery; D002423:Cause of Death; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000382:microbiology; D005625:Frontal Lobe / Q000382:microbiology; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis*; D010294:Parietal Bone / Q000382:microbiology; D010296:Parietal Lobe / Q000382:microbiology; D012189:Retrospective Studies; D012886:Skull / Q000473:pathology*; D013702:Temporal Lobe / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents