Clinical and neuroimaging features of isolated neurological melioidosis: A series of five patients

Neurological melioidosis, caused by Burkholderia pseudomallei , is a rare but serious manifestation of melioidosis that can lead to significant morbidity and mortality. This case series highlights the clinical presentations, neuroimaging findings, and management outcomes of five adult patients diagnosed with isolated neurological melioidosis between January 2019 and June 2023. All patients exhibited subacute meningoencephalitis, hemiparesis, and cerebellar signs. Neuroimaging studies revealed distinctive T2 hyperintensities and ring-enhancing lesions affecting the corticospinal tract, internal capsule, and cerebellum. The diagnosis was confirmed through positive serological tests for B. pseudomallei . Treatment with meropenem and supportive care resulted in clinical improvement in four patients, while one patient died due to the disease. This series underscores the importance of considering isolated neurological melioidosis in patients presenting with subacute meningoencephalitis, especially in endemic areas. Early diagnosis, supported by neuroimaging and serological testing, along with timely antibiotic therapy, is crucial for improving outcomes and reducing mortality in these cases.