Abstract
Rationale: Meiliodosis is an extremely rare condition in Neurosurgery which is caused by the gram negative organism Burkholderia pseudomallie. Burkholderia pseudomallei (also known as Pseudomonas pseudomallei) is a Gram-negative, bipolar, aerobic, motile rod-shaped bacterium. It is a soil-dwelling bacterium endemic in tropical and subtropical regions worldwide, particularly in Thailand and northern Australia. It infects humans and animals and causes the disease melioidosis. It is also capable of infecting plants. If treatment is below par or delayed, this infection can produce diverse clinical symptoms and result in death.
 Patient Concerns: A 52 year old female, known case of Type 2 Diabetes mellitus on insulin, presented with complaints of a swelling in the left parieto-occipital region since 2 months & headache since 1 month. She had a past history of a fall from scooter 7 months ago, which then was not radiologically imaged. Patient was, otherwise, conscious, oriented and had no focal neurological deficit.
 Diagnosis: left parieto-occipital space occupying lesion confirmed by Ct brain and [mri + mrv] brain and culture and sensitivity of fluid aspirate showed moderate growth of burkholderia pseudomallie.
 Interventions: Intravenous Ceftazidime [1 g/12 h] was administered in-hospital for 4 weeks (Intensive Phase) and Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole) {TAB.BACTRIM DS} twice daily was administered out-hospital (Maintenance Phase).
 Patient underwent Left parieto-occipital abscess drainage and debridement [Pus sent for Culture and Sensitivity] – Abscess drainage and removal of irregular thinned out bone around the skull defect + Biopsies sent from small extradural collection near the skull defect.Intravenous Ceftazidime was continued and discharged with Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole).
Highlights
Burkholderia pseudomallie -Bacterium profile: B. pseudomallei measures 2–5 μm in length and 0.4–0.8 μm in diameter and is capable of self-propulsion using flagella
Cultures typically become positive in 24 to 48 hours
The organism appears highly resistant and that again differentiates it from B. mallei, which is in contrast, exquisitely sensitive to many antibiotics
Summary
Burkholderia pseudomallie -Bacterium profile: B. pseudomallei measures 2–5 μm in length and 0.4–0.8 μm in diameter and is capable of self-propulsion using flagella. B. pseudomallei is not fastidious and grows on a large variety of culture media (blood agar, MacConkey agar, EMB, etc.). Cultures typically become positive in 24 to 48 hours (this rapid growth rate differentiates the organism from B. mallei, which typically takes a minimum of 72 hours to grow). The organism appears highly resistant (it is innately resistant to many antibiotics including colistin and gentamicin) and that again differentiates it from B. mallei, which is in contrast, exquisitely sensitive to many antibiotics. The large, wrinkled colonies look like environmental contaminants, so are often discarded as being of no clinical significance. The organism grows more slowly than other bacteria that may be present in clinical specimens, and in specimens from nonsterile sites, is overgrown. Nonsterile specimens should, be cultured in selective media (e.g., Ashdown's or B. cepacia medium). The BacT/ALERT MB system (normally used for culturing mycobacteria) by bioMérieux has been shown to have superior yields compared to conventional blood culture media
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