Cranial melioidosis presenting as osteomyelitis and/or extra-axial abscess: Literature review.

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.Literature review was performed by searching online databases for melioidosis presenting as 'osteomyelitis or scalp/extra-axial abscess(OSEAA)' . In addition, three similar cases managed at the author's institute have been presented.

Including this report of three cases, 20 cases have been reported, of whom 12 (60%)cases were from India. The mean age was 45.5 years(range, 29-74 years) and none have been in pediatric age group. Patients in 5^th-6^th decades were most frequently affected. Male:female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache and scalp swelling were commonest features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. Average intensive phase treatment duration was 4.6 weeks(range, 2-8 weeks) and 5.5 months (range, 3-12 months) for maintenance phase. Mean FU duration was 13.5 months(range,2 weeks-40months). Two deaths (10%) were reported and one case of residual frontal abscess had relapse.

Cranial melioidosis presenting as OSEAA is associated with good outcomes, in contrast to other neurologic presentations. Intensive phase for atleast 2-3 weeks followed by maintenance phase for 3-6 months is the standard treatment, similar to other melioid presentations. High degree of suspicion and accurate identification of organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.