Neurological Melioidosis (Burkholderia pseudomallei) Mimicking Guillain-Barré Syndrome

Howe, Peter W.; Holland, H.M.; Burrow, Jim; Currie, Bart J.

doi:10.1177/0310057x9702500213

Cited by 18 publications

(11 citation statements)

References 4 publications

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“…[1][2][3] Of all these complications, the most lethal and uncommon complication is the intracranial insertion, first described by Martinelle et al in 1974. [4] There are four possible pathways by which the NG tube can enter intracranially: a skull base fracture extending across the cribiform plate, a comminuted fracture involving the floor of the anterior cranial fossa, an unusually thin cribiform plate and a cribiform plate thinned by sinusitis. [5] A 55-year-old man was brought to the emergency room for head injury due to a corn thrasher, an hour after the incident.…”

Section: Fatal Inadvertent Intracranial Insertion Of a Nasogastric Tubementioning

confidence: 99%

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Cerebral abscess and calvarial osteomyelitis due to Burkholderia pseudomallei

et al. 2010

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Section: Fatal Inadvertent Intracranial Insertion Of a Nasogastric Tubementioning

confidence: 99%

“…Encephalomyelitis can mimic Guillain-Barre syndrome. [4] Because the infection is associated with a high mortality, there is a need for an early and definitive diagnosis. MRI is far more sensitive than CT scan in the early stages, and a definitive diagnosis can be established by culture.…”

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confidence: 99%

Cerebral abscess and calvarial osteomyelitis due to Burkholderia pseudomallei

et al. 2010

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“…Blood cultures of the patient later grew B.pseudomallei . Literature survey revealed 8 more cases of melioidosis where a GBS like syndrome was associated [ 5 , 6 ] but none had level 1 diagnostic certainty. Therefore, this is the first case of confirmed GBS associated with melioidosis which completely recovered with treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Neurological melioidosis is very rare [ 3 ]. Although there are several reported cases of melioidosis associated with a GBS like illness [ 4 – 6 ] only one [ 4 ] has level 1 diagnostic certainty according to Brighton criteria ( https://brightoncollaboration.org/public/resources/standards/case-definitions/main/0110/link/BC_Case%20definition_GBS.pdf ).…”

Section: Introductionmentioning

confidence: 99%

Guillaine-barre syndrome; a rare complication of melioidosis. a case report

et al. 2016

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BackgroundMelioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.Case presentationA 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew “coliforms” resistant to gentamicin and sensitive to ceftazidime.On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR].After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit.Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.ConclusionsGuillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

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“…[15] The clinical presentation of neurological melioidosis in various reports include features of aseptic meningitis, brain abscesses, brainstem encephalitis with cranial nerve palsies and acute flaccid paralysis. [3] Other CNS manifestations of melioidosis include, focal encephalitis, encephalomyelitis, cerebral abscesses, meningitis, and osteomyelitis of skull. [16] Probable mechanism of neurological melioidosis is direct invasion of the brain and spinal cord by the bacteria[17] and an exotoxin-induced neurological syndrome, with profound neurological disease occurring in the absence of apparent direct infection of the CNS.…”

Section: Discussionmentioning

confidence: 99%