Abstract. Melioidosis is an important cause of morbidity and mortality in northern Australia and Southeast Asia. Diagnosis is best made by isolation of Burkholderia pseudomallei from clinical specimens. A variety of clinical presentations are described, including neurologic disease. The aim of this study was to review admissions with confirmed neurologic melioidosis to a regional hospital in a region to which melioidosis is endemic during 1995-2011. There were 12 culture-confirmed cases of neurologic melioidosis, of which two were detected by analysis of cerebrospinal fluid. Four of these cases were in children. Significant clinical features were fever, headache, and ataxia. Common changes on magnetic resonance imaging T2-weighted scans included ring-enhancing lesions and leptomeningeal enhancement. There were four deaths and an additional four patients had significant long-term neurologic sequelae. When considering the etiology of undifferentiated neurologic disease, an awareness of the possibility of neurologic melioidosis is important in diseaseendemic regions.

Spread of microabscesses along white matter tracts and frequent trigeminal nerve involvement are unique imaging characteristics of CNS melioidosis. These findings may provide insight into potential mechanisms for B. pseuodomallei entry into the CNS through direct axonal transport in cranial nerves bypassing the blood brain barrier. Prompt recognition of the neuroimaging features of this potentially fatal infection may allow for early microbiological culture and treatment.

This study investigated GP acceptance and practical application of the Edmonton Frail Scale (EFS) in a rural primary care practice. Primary health care providers identify patients at risk of negative health outcomes and hospitalisation and then provide appropriate interventions. The annual '75+ health assessment' 75+HA is a part of the 'Enhanced Primary Care' package introduced in 1999 by the Commonwealth Department of Health and Aged Care as a financial incentive for GPs to identify and offer intervention for medical conditions and potential risk factors for poor health in people aged 75 years and over. However, the 75+HA has a number of limitations: it has not been updated, 1 takes between 30 and 60 min to complete, and from 1999 to 2010, only 20% of age-eligible adults actually had the 75+HA. 2 An alternative assessment of frailty might identify atrisk patients earlier, consume less practitioner time and have better uptake than the 75+HA. Frailty is related to the ageing process, with an accelerated decline in the ability of bodily systems to respond to and recover from physical insult. 3 Internationally, assessment of frailty in older patients by primary care physicians is government-funded 4,5 to identify patients at risk of poor health outcomes and future hospitalisation.