Central Nervous System Infection Due to Burkholderia pseudomallei: A Multicenter, 15-Year Retrospective Study From Hainan, China.

Objectives

Melioidosis is an infectious disease endemic to southeast Asia and northern Australia. Although rare, central nervous system (CNS) melioidosis carries a high mortality. This study aims to determine its clinical characteristics and provide insights facilitating its diagnosis and management.

Methods

We performed a multicenter retrospective analysis of CNS melioidosis cases at six hospitals in Hainan, China, between 2010 and 2025. Demographic and clinical data were collected and analyzed. Antimicrobial susceptibility testing was performed, and comparative statistics were calculated between survivors and non-survivors.

Results

Mortality reached 31.0% (13/42) among CNS melioidosis cases. Intracranial involvement was most common (76.2%, 32/42). Diabetes (59.5%, 25/42) was predominant risk factor. Common presentations included fever (76.2%, 32/42), headache (52.4%, 22/42), localizing neurologic signs (47.6%, 20/42), and altered consciousness (42.9%, 18/42). Bacteremia was confirmed in 59.5% (25/42) of the enrolled cases All tested isolates were susceptible to most common antibiotics. Surgical intervention and treatment with ceftazidime or trimethoprim-sulfamethoxazole were associated with lower mortality, whereas altered consciousness and diabetes were linked to poorer overall survival.

Conclusions

CNS melioidosis in Hainan predominantly affects diabetic males and frequently presents with nonspecific neurologic symptoms mimicking stroke, contributing to delayed diagnosis and high mortality. High clinical vigilance, cultures of multiple specimens, and timely antibiotics plus surgical treatment are critical for improving prognoses.