Central and peripheral nervous system involvement in neuromelioidosis

Arif, Muhammad; Abid, Muhammad Hasan; Radhakrishnan, Ramalingam; Siddiqui, Khurram A

doi:10.1136/bcr-2015-211001

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…As a result of a World Health Organization-supported laboratory-twinning project, additional cases were confirmed in the Central and Western Provinces in 2006 and 2008 [ 17 , 18 ] and surveillance for melioidosis was commenced. Recently, further cases from Sri Lanka, diagnosed locally and overseas, have been published [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Introduction and History Of Melioidosis In The Countrymentioning

confidence: 99%

Melioidosis in Sri Lanka

2018

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Until recently, Sri Lanka was not considered a country with endemic melioidosis. However, an increasing number of cases is being reported. National surveillance for melioidosis was instituted after 2008. A total of 250 culture-positive cases was recorded between 2006 and May 2017. Males predominated (71.6%). The age range was wide (2–92 years) reflecting a ubiquity of exposure. The majority (201/250, 80%) lived in rural areas. All provinces were affected. Case load increased during the two monsoonal periods (67%). There was representation of every population group including farmers (n = 44), housewives (n = 24), school children (n = 10), professionals (n = 5), businesspersons (n = 6), white-collar workers (n = 10) and blue-collar workers (n = 8). Diabetes was the predominant risk factor (n = 163, 65.2%). Clinical presentations included community-acquired sepsis and pneumonia, superficial and deep abscesses, and septic arthritis. Mortality was 20.4% (51/250). A majority (n = 212) of isolates belonged to the YLF (Yersinia-like fimbrial) clade but 38 were BTFC (B. thailandensis-like flagellum and chemotaxis). A total of 108 isolates was genotyped and 46 sequence types (STs) were identified, 40 being novel. It is clear that melioidosis is endemic in Sri Lanka with a wide geographic and demographic distribution. There is an urgent need to extend surveillance of melioidosis to under-resourced parts of the country and to populations at high risk.

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Section: Introduction and History Of Melioidosis In The Countrymentioning

confidence: 99%

Melioidosis in Sri Lanka

2018

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“…Atypical displays of neuromelioidosis include cranial nerve palsies, focal neurological deficits, brainstem encephalitis and cerebellar involvement as per Padiglione et al ,20 21 and can also present as a stroke-like illness depending on foci of involvement 22. Furthermore, a case report by Arif et al demonstrates a man in his 30s with peripheral neuropathy secondary to melioidosis 23. Few other rare presentations of neuromelioidosis reported are cerebral/dural(sagittal) sinus thrombosis and mimicking acute transverse myelitis 20 24 25…”

Section: Discussionmentioning

confidence: 98%

Critical approach to atypical spectrum of melioidosis: a case-series based literature review

et al. 2022

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Melioidosis is an emerging infectious disease with highest predominance in Southeast Asia, but it has a significantly lower incidence across other parts of the globe. The most common systemic involvement seen in melioidosis is pulmonary, followed by multiple visceral and cutaneous abscesses. Infrequently, melioidosis manifests with atypical presentations such as spontaneous bacterial peritonitis (SBP), acute pyogenic meningitis or septic arthritis. Our primary case discusses an extremely rare presentation of melioidosis with SBP. There have not been any cases of SBP reported secondary to melioidosis infection. The second case exhibits development of acute pyogenic meningitis from haematogenous dissemination of this organism, while the final case demonstrates musculoskeletal melioidosis as an uncommon presentation. Of note, this case series also discusses the guidelines of management of melioidosis and illustrates the tremendous impact of appropriate and timely antibiotic therapy on mortality and morbidity secondary to melioidosis.

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“…5 Systemic manifestations such as concurrent lung involvement are seen in more than 50% of patients, and overlying osteomyelitis of the skull or a scalp abscess is found in more than 25% of patients. 6 Isolated NM is more difficult to diagnose, and although the CSF shows pleocytosis, high protein, and reduced glucose, CSF studies rarely isolate the organism (because of sequestration). Repeated tissue biopsy and culture are often required to confirm the diagnosis.…”

Section: Case Reportmentioning

confidence: 99%

Case Report: Ascending Myelo-Encephalitis after a Penetrating Injury to the Foot: An Atypical Case of Neuromelioidosis

Maramattom

Rathish

2021

The American Journal of Tropical Medicine and Hygiene

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Organisms penetrate the central nervous system (CNS) via three routes. The commonest is the hematogenous route, and other routes include contiguous or penetrating injury or rarely via retrograde axoplasmic route. Although the axoplasmic highway is often used by viruses, only a few bacteria are known to penetrate the CNS via this route. We present a 57-year-old man who developed a penetrating injury while working in a field. Over the next 4 months, he developed pain at the site of the poorly healing wound, which ascended up the right leg and presented as a conus-cauda syndrome. Magnetic resonance imaging (MRI) showed an enhancing intradural intramedullary enhancing lesion in the conus on the right side with cord edema from D11 to L1 level. Extensive evaluation was negative, and he continued to progress to holocord myelitis and developed bilateral corticospinal tract lesions (“tractopathy”) in the brain stem and internal capsule. He died after developing a right-sided cerebritis with mass effect. Tissue biopsy from the brain at the time of decompressive craniectomy grew Burkholderia pseudomallei and confirmed a diagnosis of neuromelioidosis (NM). We reviewed the literature for NM, its variable presentations, and the concept of an “infectious tractopathy” and imaging findings which could generate suspicion of this entity.

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Central and peripheral nervous system involvement in neuromelioidosis

Cited by 6 publications

References 8 publications

Melioidosis in Sri Lanka

Melioidosis in Sri Lanka

Critical approach to atypical spectrum of melioidosis: a case-series based literature review

Case Report: Ascending Myelo-Encephalitis after a Penetrating Injury to the Foot: An Atypical Case of Neuromelioidosis

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