Differential Diagnosis for Severe CNS Meliodosis

• Single most likely diagnosis
  • Meliodosis: This is the most likely diagnosis given the presentation of severe CNS meliodosis. Meliodosis is a bacterial infection caused by Burkholderia pseudomallei, which can affect various parts of the body, including the central nervous system (CNS), leading to severe symptoms.
• Other Likely diagnoses
  • Meningitis: Bacterial meningitis, particularly caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae, can present with severe CNS symptoms similar to meliodosis.
  • Encephalitis: Viral encephalitis, such as herpes simplex encephalitis, can cause severe CNS symptoms, including fever, headache, and altered mental status.
  • Brain Abscess: A brain abscess, which is a collection of pus in the brain tissue, can cause severe CNS symptoms, including fever, headache, and focal neurological deficits.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid Hemorrhage: Although not an infectious cause, a subarachnoid hemorrhage can present with sudden onset of severe headache and altered mental status, mimicking severe CNS meliodosis.
  • Cerebral Malaria: In endemic areas, cerebral malaria caused by Plasmodium falciparum can present with severe CNS symptoms, including coma and seizures.
  • Rickettsial Infections: Infections such as Rocky Mountain spotted fever or typhus can cause severe CNS symptoms, including fever, headache, and altered mental status.
• Rare diagnoses
  • Lyme Neuroborreliosis: A rare cause of CNS symptoms, particularly in endemic areas, caused by the bacterium Borrelia burgdorferi.
  • Cysticercosis: A parasitic infection caused by the pork tapeworm Taenia solium, which can cause CNS symptoms, including seizures and hydrocephalus.
  • Whipple's Disease: A rare systemic bacterial infection caused by Tropheryma whipplei, which can cause CNS symptoms, including dementia, seizures, and supranuclear ophthalmoplegia.