Dados do Trabalho

Título

Neurological melioidosis: A case report.

RESUMO

Female, 54 years old, with SAH and DM 2, on 05/10/2021 she started inappetence, nausea and muscle fatigue. She evolved 7 days later with unmeasured fever, drowsiness and the appearance of a painful nodular lesion on the scalp.; after three days she had temporo-spatial disorientation and generalized tonic-clonic seizures. Attended at the HGF emergency room, brain MRI showed changes in tissues from the face to the galea, intradiploeal and subdural collections, irregular pachymeningeal enhancement, T2/FLAIR hypersignal and diffusion restriction in the left parietal lobe suggestive of cerebritis, MR angiography with thrombosis sigmoid sinus and CSF study 1182 red blood cells, 9 leukocytes (neutrophils 77%, lymphocytes 22%), proteins 49mg/dl, glucose 55mg/dl, LDH 41, ADA 0.1 and oncotic cells, fungi, BAAR, VDRL and negative cultures. She worsened clinically, requiring mechanical ventilation in the ICU. The pathogen Burkholderia pseudomallei was isolated from three blood culture samples and treated with meropenem for 8 weeks. In the eradication treatment, he developed pancytopenia secondary to the use of sulfamethoxazole-trimetropine. He was discharged with negative blood cultures for outpatient treatment with amoxicillin-clavulanate.
Melioidosis is caused by the gran-negative bacillus Burkholderia pseudomallei, responsible for 89,000 annual deaths worldwide. In Ceará, the first case was described in 2003. In 2005 it became a notifiable disease. The infection occurs by inhalation/inoculation of the pathogen; is confirmed by culture or PCR. In the neurological form, extracranial lesions occur, may involve contiguous sites, sub or extradural collections, brain micro or macroabscesses, cranial/spinal osteomyelitis, leptomeningitis, meningonencephalitis, brainstem encephalitis with cranial nerve palsy, myelitis and dural venous sinus thrombosis. Risk factors such as DM2, alcohol, COPD, chronic kidney disease can lead to a worse outcome. Intensive treatment varies from 14 days to 8 weeks according to severity, with carbapenems or ceftazidime. Eradication treatment lasts up to 12 weeks, using trimethoprim-sulfamethoxazole to prevent recrudescence. Doxycycline and amoxicillin-clavulanate are options.
In endemic areas, it is crucial to maintain high clinical suspicion in cases in which the image suggests the possibility of a diagnosis of the neurological form, helping the rapid institution of therapy due to the risk of severe and fatal evolution.

Palavras Chave

Neurological melioidosis, Burkholderia pseudomallei, Ceará

Área

Neuroinfecção