Rare Presentations of CNS Melioidosis - An Institutional Experience

CNS Melioidosis is rare and presents as an abscess secondary to haematogenous spread from the lungs. The presentation is typical for a brain abscess and the treatment is surgical excision followed by medical therapy. Prognosis depends greatly on the susceptibility of the bacteria to multimodal chemotherapy, recurrence thus being a major cause of morbidity. The incidence is now much worse since the global explosion of HIV/AIDS where immunosuppression leads to atypical and aggressive presentations. We present two atypical presentations, which required a high index of suspicion along with a multidisciplinary team approach to ensure appropriate treatment and good results. The write up highlights the complexities of presentation, operative dilemmas and eventual course of treatment in a tertiary care centre in south India.