{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:08Z","timestamp":1776096488347,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      Melioidosis, caused by\n                      <jats:italic>Burkholderia pseudomallei<\/jats:italic>\n                      , is an opportunistic infection endemic to Southeast Asia. CNS involvement is rare, but is associated with significant morbidity and mortality. Subdural empyema arising from odontogenic melioidosis has been rarely reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A 50-year-old male with newly diagnosed diabetes mellitus presented with progressive right facial swelling, fever, and dizziness 1 week following dental extraction. CT of the head and neck revealed a right masticator space abscess with extension into the parotid and extraconal orbital spaces. Blood cultures isolated\n                      <jats:italic>B. pseudomallei<\/jats:italic>\n                      . Despite intravenous meropenem, the infection progressed to a right temporal lobe abscess with adjacent subdural empyema, as well as subperiosteal and lateral rectus muscle abscesses. The patient underwent right-sided craniotomy with drainage of the subdural abscess and anterior temporal lobectomy. Intraoperative findings confirmed extensive granulation tissue and a localized subdural abscess near the precentral gyrus. Postoperatively, he experienced refractory seizures requiring multiple antiepileptic agents. Follow-up CT imaging of the brain showed interval resolution of abscesses and improving craniofacial inflammation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>\n                      Although CNS involvement by\n                      <jats:italic>B. pseudomallei<\/jats:italic>\n                      is rare, early recognition and prompt intervention are crucial in achieving satisfactory infection control.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25519\">https:\/\/thejns.org\/doi\/10.3171\/CASE25519<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25519","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:14Z","timestamp":1776094034000},"source":"Crossref","is-referenced-by-count":0,"title":["Contiguous spread of melioidosis to the brain: a rare case of subdural empyema following odontogenic infection. Illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0670-8693","authenticated-orcid":true,"given":"Candice H. W.","family":"Lam","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Prince of Wales Hospital, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1681-1441","authenticated-orcid":true,"given":"Benjamin","family":"Chan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor K. H.","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Prince of Wales Hospital, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danny T. M.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Prince of Wales Hospital, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Nat Rev Dis Primers","first-page":"17107","article-title":"Melioidosis","volume":"4","author":"Wiersinga","year":"2018","unstructured":"Wiersinga WJVirk HSTorres AGMelioidosis. Nat Rev Dis Primers. 2018;4:17107. doi:10.1038\/nrdp.2017.107"},{"issue":"3","key":"bib2","series-title":"Trop Med Infect Dis","first-page":"91","article-title":"Melioidosis in Hong Kong","volume":"3","author":"Lui","year":"2018","unstructured":"Lui GTam ATso EYKMelioidosis in Hong Kong. Trop Med Infect Dis. 2018;3(3):91. doi:10.3390\/tropicalmed3030091"},{"key":"bib3","article-title":"A melioidosis case confirmed by the Centre for Health Protection.","author":"Hong Kong Government","year":"2025","unstructured":"Hong Kong Government.A melioidosis case confirmed by the Centre for Health Protection. Published February 21, 2025. Accessed February 1, 2026. https:\/\/www.info.gov.hk\/gia\/general\/202502\/21\/P2025022100400.htm"},{"issue":"1","key":"bib4","series-title":"Semin Respir Crit Care Med","first-page":"111","article-title":"Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment","volume":"36","author":"Currie","year":"2015","unstructured":"Currie BJ.Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respir Crit Care Med. 2015;36(1):111-125. doi:10.1055\/s-0034-1398389"},{"key":"bib5","series-title":"Lancet Reg Health Southeast Asia","first-page":"100004","article-title":"Burden of melioidosis in India and South Asia: challenges and ways forward","volume":"2","author":"Mohapatra","year":"2022","unstructured":"Mohapatra PRMishra B.Burden of melioidosis in India and South Asia: challenges and ways forward. Lancet Reg Health Southeast Asia. 2022;2:100004. doi:10.1016\/j.lansea.2022.03.004"},{"issue":"10","key":"bib6","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1170","article-title":"Neurological melioidosis: a 15-year prospective study from northern Australia","volume":"83","author":"Meumann","year":"2012","unstructured":"Meumann EMNeurological melioidosis: a 15-year prospective study from northern Australia. J Neurol Neurosurg Psychiatry. 2012;83(10):1170-1176."},{"issue":"1","key":"bib7","series-title":"Cureus","first-page":"e53249","article-title":"Subdural empyema as a complication of sinusitis: a diagnosis to keep in mind","volume":"16","author":"E\u00e7a","year":"2024","unstructured":"E\u00e7a RGra\u00e7a AFrancisco RPamplona J.Subdural empyema as a complication of sinusitis: a diagnosis to keep in mind. Cureus. 2024;16(1):e53249. doi:10.7759\/cureus.53249"},{"issue":"1","key":"bib8","series-title":"Trop Med Infect Dis","first-page":"25","article-title":"Melioidosis in Malaysia: incidence, clinical challenges, and advances in understanding pathogenesis","volume":"3","author":"Nathan","year":"2018","unstructured":"Nathan SChieng SKingsley PVMelioidosis in Malaysia: incidence, clinical challenges, and advances in understanding pathogenesis. Trop Med Infect Dis. 2018;3(1):25. doi:10.3390\/tropicalmed3010025"},{"issue":"4","key":"bib9","series-title":"Am J Trop Med Hyg","first-page":"1252","article-title":"Identification and characterization of Burkholderia pseudomallei from localized pyogenic infections in Eastern India: a clinico-microbiological study","volume":"104","author":"Purushotham","year":"2021","unstructured":"Purushotham PMohanty SChappity PMishra TSMahapatra A.Identification and characterization of Burkholderia pseudomallei from localized pyogenic infections in Eastern India: a clinico-microbiological study. Am J Trop Med Hyg. 2021;104(4):1252-1259. doi:10.4269\/ajtmh.20-1386"},{"issue":"9","key":"bib10","series-title":"Indian J Ophthalmol","first-page":"1400","article-title":"Orbital melioidosis masquerading as orbital cellulitis: a case report","volume":"66","author":"Rajendran","year":"2018","unstructured":"Rajendran ROrbital melioidosis masquerading as orbital cellulitis: a case report. Indian J Ophthalmol. 2018;66(9):1400-1402."},{"issue":"7","key":"bib11","series-title":"Singapore Med J","first-page":"e250","article-title":"Melioidosis presenting as parotid abscess: a case report and literature review","volume":"50","author":"Lim","year":"2009","unstructured":"Lim SHMelioidosis presenting as parotid abscess: a case report and literature review. Singapore Med J. 2009;50(7):e250-e252."},{"issue":"4","key":"bib12","series-title":"Neurol India","first-page":"1100","article-title":"Melioidosis mimicking tuberculous vertebral osteitis: case report and review of literature","volume":"66","author":"Pande","year":"2018","unstructured":"Pande ANambi PSPandian SSubramanian SGhosh S.Melioidosis mimicking tuberculous vertebral osteitis: case report and review of literature. Neurol India. 2018;66(4):1100-1105. doi:10.4103\/0028-3886.236976"},{"issue":"4","key":"bib13","series-title":"PLOS Negl Trop Dis","first-page":"e0007320","article-title":"Central nervous system melioidosis: a systematic review of individual participant data of case reports and case series","volume":"13","author":"Wongwandee","year":"2019","unstructured":"Wongwandee MLinasmita P.Central nervous system melioidosis: a systematic review of individual participant data of case reports and case series. 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Int J Antimicrob Agents. 2014;43(4):310-318. doi:10.1016\/j.ijantimicag.2014.01.005"},{"issue":"suppl 1","key":"bib16","series-title":"J Neurosci Rural Pract","first-page":"S67","article-title":"Brain abscess: current management","volume":"4","author":"Alvis Miranda","year":"2013","unstructured":"Alvis Miranda HCastellar-Leones SMElzain MAMoscote-Salazar LR.Brain abscess: current management. J Neurosci Rural Pract. 2013;4(suppl 1):S67-S81. doi:10.4103\/0976-3147.116472"},{"key":"bib17","series-title":"Surg Neurol Int","first-page":"58","article-title":"Concomitant extradural, subdural, and intraparenchymal abscesses of the brain in a patient with cerebral melioidosis\u2014a case report","volume":"13","author":"Chandra","year":"2022","unstructured":"Chandra KRajesh BJ.Concomitant extradural, subdural, and intraparenchymal abscesses of the brain in a patient with cerebral melioidosis\u2014a case report. 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Neurology. 2020;95(18):836-837. doi:10.1212\/WNL.0000000000010835"},{"issue":"2","key":"bib26","series-title":"Neurol India","first-page":"767","article-title":"Corticospinal tract involvement in MRI of neuromelioidosis: report of three cases with a review of clinicoradiological features","volume":"70","author":"Raj","year":"2022","unstructured":"Raj JVNagarajan KAnanthanarayanan KSwaminathan RPBammigatti C.Corticospinal tract involvement in MRI of neuromelioidosis: report of three cases with a review of clinicoradiological features. Neurol India. 2022;70(2):767-771. doi:10.4103\/0028-3886.344622"},{"issue":"1","key":"bib27","series-title":"Diagn Microbiol Infect Dis","first-page":"116885","article-title":"Neuromelioidosis in a child from Southern India: diagnostic and therapeutic insights","volume":"113","author":"U","year":"2025","unstructured":"U PBAshraf AARoy A.Neuromelioidosis in a child from Southern India: diagnostic and therapeutic insights. Diagn Microbiol Infect Dis. 2025;113(1):116885. doi:10.1016\/j.diagmicrobio.2025.116885"},{"key":"bib1","series-title":"Nat Rev Dis Primers","first-page":"17107","article-title":"Melioidosis","volume":"4","author":"Wiersinga","year":"2018","unstructured":"Wiersinga WJVirk HSTorres AGMelioidosis. Nat Rev Dis Primers. 2018;4:17107. doi:10.1038\/nrdp.2017.107"},{"issue":"3","key":"bib2","series-title":"Trop Med Infect Dis","first-page":"91","article-title":"Melioidosis in Hong Kong","volume":"3","author":"Lui","year":"2018","unstructured":"Lui GTam ATso EYKMelioidosis in Hong Kong. Trop Med Infect Dis. 2018;3(3):91. doi:10.3390\/tropicalmed3030091"},{"key":"bib3","article-title":"A melioidosis case confirmed by the Centre for Health Protection.","author":"Hong Kong Government","year":"2025","unstructured":"Hong Kong Government.A melioidosis case confirmed by the Centre for Health Protection. Published February 21, 2025. Accessed February 1, 2026. https:\/\/www.info.gov.hk\/gia\/general\/202502\/21\/P2025022100400.htm"},{"issue":"1","key":"bib4","series-title":"Semin Respir Crit Care Med","first-page":"111","article-title":"Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment","volume":"36","author":"Currie","year":"2015","unstructured":"Currie BJ.Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respir Crit Care Med. 2015;36(1):111-125. doi:10.1055\/s-0034-1398389"},{"key":"bib5","series-title":"Lancet Reg Health Southeast Asia","first-page":"100004","article-title":"Burden of melioidosis in India and South Asia: challenges and ways forward","volume":"2","author":"Mohapatra","year":"2022","unstructured":"Mohapatra PRMishra B.Burden of melioidosis in India and South Asia: challenges and ways forward. Lancet Reg Health Southeast Asia. 2022;2:100004. doi:10.1016\/j.lansea.2022.03.004"},{"issue":"10","key":"bib6","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1170","article-title":"Neurological melioidosis: a 15-year prospective study from northern Australia","volume":"83","author":"Meumann","year":"2012","unstructured":"Meumann EMNeurological melioidosis: a 15-year prospective study from northern Australia. J Neurol Neurosurg Psychiatry. 2012;83(10):1170-1176."},{"issue":"1","key":"bib7","series-title":"Cureus","first-page":"e53249","article-title":"Subdural empyema as a complication of sinusitis: a diagnosis to keep in mind","volume":"16","author":"E\u00e7a","year":"2024","unstructured":"E\u00e7a RGra\u00e7a AFrancisco RPamplona J.Subdural empyema as a complication of sinusitis: a diagnosis to keep in mind. 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Trop Med Infect Dis. 2018;3(1):25. doi:10.3390\/tropicalmed3010025"},{"issue":"4","key":"bib9","series-title":"Am J Trop Med Hyg","first-page":"1252","article-title":"Identification and characterization of Burkholderia pseudomallei from localized pyogenic infections in Eastern India: a clinico-microbiological study","volume":"104","author":"Purushotham","year":"2021","unstructured":"Purushotham PMohanty SChappity PMishra TSMahapatra A.Identification and characterization of Burkholderia pseudomallei from localized pyogenic infections in Eastern India: a clinico-microbiological study. Am J Trop Med Hyg. 2021;104(4):1252-1259. doi:10.4269\/ajtmh.20-1386"},{"issue":"9","key":"bib10","series-title":"Indian J Ophthalmol","first-page":"1400","article-title":"Orbital melioidosis masquerading as orbital cellulitis: a case report","volume":"66","author":"Rajendran","year":"2018","unstructured":"Rajendran ROrbital melioidosis masquerading as orbital cellulitis: a case report. Indian J Ophthalmol. 2018;66(9):1400-1402."},{"issue":"7","key":"bib11","series-title":"Singapore Med J","first-page":"e250","article-title":"Melioidosis presenting as parotid abscess: a case report and literature review","volume":"50","author":"Lim","year":"2009","unstructured":"Lim SHMelioidosis presenting as parotid abscess: a case report and literature review. Singapore Med J. 2009;50(7):e250-e252."},{"issue":"4","key":"bib12","series-title":"Neurol India","first-page":"1100","article-title":"Melioidosis mimicking tuberculous vertebral osteitis: case report and review of literature","volume":"66","author":"Pande","year":"2018","unstructured":"Pande ANambi PSPandian SSubramanian SGhosh S.Melioidosis mimicking tuberculous vertebral osteitis: case report and review of literature. 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