Neuromelioidosis causing rapidly progressing neurological syndromes mimicking stroke and demyelination: Insights from a case series.

Melioidosis (Whitmores disease) is caused by Burkholderia pseudomallei, a Gram-negative saprophytic bacterium. In addition to systemic involvement, this neurotropic pathogen can invade the meninges, cranial nerves, brain, and spinal cord, resulting in diverse neurological manifestations. We describe four cases of neuromelioidosis encountered at our urban tertiary institute over a one-year period. All presented with rapidly progressive neurological symptoms mimicking stroke and acute disseminated encephalomyelitis (ADEM). The case series included three males and one female, aged between 32 and 65 years. Two were farmers, and three had diabetes mellitus. The diagnosis was not initially suspected and features like endemicuty and atypical features like fever, facial pain and ulcer led to suspicion of an alternative diagnosis which was confirmed later through blood or pus culture. Two patients achieved complete recovery, one had partial recovery, and one patient succumbed to the illness. This report aims to raise awareness among the medical community regarding the neurological presentations of melioidosis. Also, with recent increase in travel across the world , neuromelioidosis may be considered even in nonendemic areas in the appropriate clinical setting.