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Ni HY, Zhang Y, Huang DH, Zhou F. Multi-systemic melioidosis in a patient with type 2 diabetes in non-endemic areas: A case report and review of literature. World J Clin Cases 2024; 12:1669-1676. [PMID: 38576731 PMCID: PMC10989420 DOI: 10.12998/wjcc.v12.i9.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/05/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Melioidosis, an infectious disease caused by Burkholderia pseudomallei (B. pseudomallei), occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a high mortality rate. CASE SUMMARY A 58-year-old woman presented with scattered erythema on the skin of her limbs, followed by fever and seizures. B. pseudomallei was isolated successively from the patient's urine, blood, and pus. Magnetic resonance imaging showed abscess formation involving the right forehead and the right frontal region. Subsequently, abscess resection and drainage were performed. The patient showed no signs of relapse after 4 months of follow-up visits post-treatment. CONCLUSION We present here a unique case of multi-systemic melioidosis that occurs in non-endemic regions in a patient who had no recent travel history. Hence, it is critical to enhance awareness of melioidosis in non-endemic regions.
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Affiliation(s)
- Huan-Yu Ni
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Dong-Hai Huang
- Department of Rheumatology and Immunology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Feng Zhou
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
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2
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Imaging of Uncommon Bacterial, Rickettsia, Spirochete, and Fungal Infections. Neuroimaging Clin N Am 2023; 33:83-103. [DOI: 10.1016/j.nic.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Cycle-Inhibiting Factor Is Associated with Burkholderia pseudomallei Invasion in Human Neuronal Cells. BIOLOGY 2022; 11:biology11101439. [PMID: 36290346 PMCID: PMC9598235 DOI: 10.3390/biology11101439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
Abstract
Burkholderia pseudomallei is a pathogenic bacterium that causes human melioidosis, which is associated with a high mortality rate. However, the underlying mechanisms of B. pseudomallei pathogenesis are largely unknown. In this study, we examined the infection of human neuronal SH-Sy5y cells by several clinically relevant B. pseudomallei strains. We found that all tested B. pseudomallei strains can invade SH-Sy5y cells, undergo intracellular replication, cause actin-tail formation, and form multinucleated giant cells. Additionally, a deletion mutant of B. pseudomallei cycle-inhibiting factor (cif) was constructed that exhibited reduced invasion in SH-Sy5y cells. Complementation of cif restored invasion of the B. pseudomallei cif-deleted mutant. Our findings enhance understanding of B. pseudomallei pathogenicity in terms of the virulence factor Cif and demonstrate the function of Cif in neurological melioidosis. This may eventually lead to the discovery of novel targets for treatment and a strategy to control the disease.
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Bahuleyan B, Adarsh M, Akarsh J, M. L. AK, Rohitha CS, Elenjickal GX, T. V. S, Thomas SG. Cerebral venous sinus thrombosis as a complication of cranial melioidosis – a rare case report. Access Microbiol 2022; 4:acmi000357. [PMID: 36003365 PMCID: PMC9394529 DOI: 10.1099/acmi.0.000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Cerebral venous sinus thrombosis is a rare complication of cranial melioidosis. We report a case of an adult male who presented with skull osteomyelitis, transverse sinus thrombosis and multiple brain abscesses. His blood cultures grew
Burkholderia pseudomallei
. The patient finally succumbed after multiple recurrences of the infection despite surgical excision of the osteomyelitic bone and the recommended antibiotic treatment. The management of cerebral venous sinus thrombosis in patients with cranial melioidosis is discussed along with a brief review of the literature.
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Affiliation(s)
- Biji Bahuleyan
- Department of Neurosurgery, Lisie Hospital, Ernakulam, Kerala, India
| | - Manuel Adarsh
- Department of Neurosurgery, Lisie Hospital, Ernakulam, Kerala, India
| | | | - Arun Kumar M. L.
- Department of Neurology, Lisie Hospital, Ernakulam, Kerala, India
| | | | | | - Sreevalsan T. V.
- Department of Critical care Medicine, Lisie Hospital, Ernakulam, Kerala, India
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Cornelius LP, Neeraj E, Venkateswaran KJ, Gopinathan K. Neuromelioidosis Presenting as Bells Palsy in a Child. Ann Indian Acad Neurol 2022; 25:302-303. [PMID: 35693644 PMCID: PMC9175429 DOI: 10.4103/aian.aian_316_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/16/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Leema P Cornelius
- Department of Paediatric Neurology, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - E Neeraj
- Department of Paediatric Neurology, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - K J Venkateswaran
- Department of Paediatric Neurology, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - K Gopinathan
- Department of Radiology, Govt. Royapettah Hospital, Kilpauk Medical College, Chennai, Tamil Nadu, India
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Rudrabhatla P, Nair SS, George J, Sekar S, Ponnambath DK. Isolated Myelitis and Intramedullary Spinal Cord Abscess in Melioidosis-A Case Report. Neurohospitalist 2022; 12:131-136. [PMID: 34950401 PMCID: PMC8689550 DOI: 10.1177/19418744211025386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Neuromelioidosis is a severe tropical infection with high morbidity and mortality. Isolated myelitis is an extremely rare manifestation of melioidosis which may evade diagnosis. We report a 69-year-old diabetic male patient who presented with acute flaccid paraplegia and longitudinally extensive myelitis and no systemic symptoms. MRI of spinal cord showed lower dorsal cord and conus T2 hyperintensity and microabscesses with dural enhancement. The diagnosis was clinched with blood culture growing Burkholderia pseudomallei. He rapidly developed colitis, septicemia and multiorgan dysfunction and succumbed to the illness in spite of antibiotics and aggressive supportive care. The case highlights that melioidosis should be considered as a differential diagnosis of infectious myelitis, especially in the tropics. Presence of a neutrophilic blood and cerebrospinal fluid picture and microabscesses in spinal cord are important diagnostic clues. The outcome is dismal unless the diagnosis is considered early in the disease course and managed expeditiously with sensitive antibiotics.
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Affiliation(s)
- Pavankumar Rudrabhatla
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sruthi S. Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jithin George
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarish Sekar
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Dinoop Korol Ponnambath
- Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Muthina RA, Koppara NK, Bethasaida Manuel M, Bommu AN, Anapalli SR, Boju SL, Rapur R, Vishnubotla SK. Cerebral abscess and calvarial osteomyelitis caused by Burkholderia pseudomallei in a renal transplant recipient. Transpl Infect Dis 2020; 23:e13530. [PMID: 33248011 DOI: 10.1111/tid.13530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 02/03/2023]
Abstract
Melioidosis is an infection of humans caused by the saprophytic bacterium Burkholderia (previously Pseudomonas) pseudomallei. We present a patient of cerebral abscess and calvarial osteomyelitis caused by B. pseudomallei in a renal transplant recipient. We treated the patient with ceftazidime for 3 weeks, followed by trimethoprim-sulfamethoxazole (TMP-SMX) for 6 months. The superficial abscess reduced in size at the end of first month and subsided gradually. A repeat MRI showed reduction in intracranial abscess. The patient had no neurological deficit.
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Affiliation(s)
| | | | | | - Alekhya Naga Bommu
- Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | | | | | - Ram Rapur
- Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Wu H, Huang D, Wu B, Pan M, Lu B. Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review. BMC Infect Dis 2019; 19:984. [PMID: 31752745 PMCID: PMC6873490 DOI: 10.1186/s12879-019-4627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/11/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Burkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE. CASE PRESENTATION A 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission. CONCLUSIONS This study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.
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Affiliation(s)
- Hua Wu
- Department of Laboratory Medicine, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Dongliang Huang
- Department of Emergency, Hainan Armed Police Corps Hospital, Wenmingdong Road, Meilan District, Haikou, 570203 China
| | - Biao Wu
- Department of Infectious Diseases, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Mengjie Pan
- Department of Radiology, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
- Center for Respiratory Diseases, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
- National Clinical Research Center of Respiratory Diseases, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
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Prasad GL. Cranial Melioidosis Presenting as Osteomyelitis and/or Extra-Axial Abscess: Literature Review. World Neurosurg 2019; 134:67-75. [PMID: 31629141 DOI: 10.1016/j.wneu.2019.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Central nervous system (CNS) melioidosis is rare. Clinical presentations depend on the region of endemicity. Despite treatment, neurologic disease has relatively high mortality rates. Less than 80 cases of CNS involvement have been reported. METHODS A literature review was performed by searching online databases for melioidosis presenting as osteomyelitis or scalp/extra-axial abscess (OSEAA). In addition, 3 similar cases managed at my institute have been presented. RESULTS Including this report of 3 cases, 20 additional cases have been reported. Of these, 12 cases (60%) were from India. The mean age of patients was 45.5 years (range, 29-74 years), and none were in the pediatric age group. Patients in the fifth to sixth decades were most frequently affected. The male to female ratio was 5.3:1. Eleven patients had predisposing factors. Fever, headache, and scalp swelling were the most common features. Five cases had history of previous melioid infection. Seven cases had systemic disease. Debridement was performed in 11 cases. The average intensive phase treatment duration was 4.6 weeks (range, 2-8 weeks) and 5.5 months (range, 3-12 months) for the maintenance phase. Mean follow-up duration was 13.5 months (range, 2 weeks-40 months). Two deaths (10%) were reported, and 1 case of residual frontal abscess had relapse. CONCLUSIONS Cranial melioidosis presenting as OSEAA is associated with good outcome, in contrast with other neurologic presentations. Intensive phase for at least 2-3 weeks followed by maintenance phase for 3-6 months is the standard treatment, similar to other melioid presentations. A high degree of suspicion and accurate identification of the organism is crucial. Patients need to be monitored for recurrences, both clinically and radiologically.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
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10
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Amarasena HLP, Silva FHDS, Tilakaratna PMYI, Jayamanne SF, Ranawaka UK. Melioidosis with a subdural collection - a case report. BMC Infect Dis 2019; 19:143. [PMID: 30755178 PMCID: PMC6373098 DOI: 10.1186/s12879-019-3782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.
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Affiliation(s)
- H. L. P. Amarasena
- Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - F. H. D. S. Silva
- Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - S. F. Jayamanne
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - U. K. Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Peh WM, Hean GG, Clement YHR. The Tunnel Sign Revisited: A Novel Observation of Cerebral Melioidosis Mimicking Sparganosis. J Radiol Case Rep 2018; 12:1-11. [PMID: 30651915 PMCID: PMC6312124 DOI: 10.3941/jrcr.v12i8.3441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The tunnel sign has been described as a specific feature of cerebral sparganosis. We present a case of a 55-year-old gentleman found to have cerebral melioidosis and with initial imaging mimicking the appearance of sparganosis. This suggests that the tunnel sign in brain abscesses may be specific for infection by Burkholderia Pseudomallei, Spirometra Mansoni or Listeria Monocytogenes.
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Affiliation(s)
- Wee Ming Peh
- Department of Diagnostic Imaging, National University Hospital, Singapore
- Department of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore
| | - Goh Giap Hean
- Department of Pathology, National University of Singapore, Singapore
| | - Yong Hsiang Rong Clement
- Department of Diagnostic Imaging, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
BACKGROUND Neuromelioidosis is a rare conduction, which is difficult to diagnose and treat. CASE CHARACTERISTICS Preadolescent girl presenting with prolonged fever, acute ascending paralysis and encephalopathy. OUTCOME Neuromelioidiosis was confirmed on brain biopsy culture. Patient improved with an intensive antibiotic regimen. MESSAGE Neuromelioidosis can mimic acute demyelinating encephalomyelitis clinically and radiologically.
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Central nervous system melioidosis in the pediatric age group: review. Childs Nerv Syst 2017; 33:1-6. [PMID: 28451778 DOI: 10.1007/s00381-017-3422-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/19/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Melioidosis is a potentially fatal infectious disease caused by Burkholderia pseudomallei. Neurologic involvement in pediatric age group is very rare, and only a handful of cases have been reported in literature. We sought to provide a systematic review of pediatric neurologic melioidosis. METHODS Literature review was performed to analyze reported cases of pediatric neurologic melioidosis (≤16 years) by searching online database (PubMed/MEDLINE). RESULTS Twenty-seven cases were analyzed. Mean age was 6.7 years (range 2 days-14 years) and around 50% were older children (>5 years). Cranial nerve palsies and fever were most common presenting features. Major manifestations were meningoencephalitis in 16 (59%) and cerebral abscesses in eight (29%) cases. Abscesses were mostly located in parietal lobe. Among older children, abscesses were common than meningeal disease, while being converse for neonates. Mean follow-up duration was 11.5 months. Ten cases showed good to excellent outcome, while eight cases had fair (incomplete recovery) outcomes. The overall mortality rate was 18.5% (5/27) and tends to decrease with age. Among the five deaths, 4 (80%) had septicemia or pneumonia. CONCLUSIONS Pediatric neurologic melioidosis is very rare. Meningoencephalitis is the most common presentation. Mortality is the highest in neonates. Ceftazidime appears to be the drug of choice in intensive phase, although the best drug in maintenance phase cannot be commented upon, especially in very young children.
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Abstract
Melioidosis, which is caused by Burkholderia pseudomallei, is predominately a disease of tropical climates and is especially widespread in south-east Asia and northern Australia. Melioidosis affecting the central nervous system has a low incidence but a high mortality. We present seven cases of neuromelioidosis and analyze the disease characteristics and imaging features. Typical clinical features of this disease included high fever and headache. Five patients had an irregular fever with a temperature ≥ 39℃. Peripheral blood leukocytes and the neutrophil ratio were raised in all patients. On computed tomography and magnetic resonance imaging the disease mainly manifested as intracerebral single or multiple nodules, as well as ring and flake-like enhancements with rapid lesion progression. This study demonstrated the importance of imaging examination in the clinical evaluation and diagnosis of neuromelioidosis.
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Affiliation(s)
- Yuefu Zhan
- 1 Department of Radiology, Haikou Municipal People's Hospital, Hainan, China
| | - Yehua Wu
- 2 Department of Anaesthesiology, Hainan Provincial People's Hospital, Hainan, China
| | - Qun Li
- 3 Department of Pathology, Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Anle Yu
- 1 Department of Radiology, Haikou Municipal People's Hospital, Hainan, China
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Central Nervous System Melioidosis Mimics Malignancy: A Case Report and Literature Review. World Neurosurg 2016; 89:732.e19-23. [PMID: 26882971 DOI: 10.1016/j.wneu.2016.01.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Central nervous system (CNS) melioidosis is notorious because of the difficulty in bacteria eradication and the destruction of brain structures. Early manifestation of CNS melioidosis mimics malignancy or stroke. We present a case of CNS melioidosis that initially manifested as malignancy. CASE DESCRIPTION A 30-year-old man presented with sudden onset of left limb weakness and seizure. Computed tomography of the brain showed a low-density lesion over the right parietal lobe, and magnetic resonance imaging showed a well-enhanced lobulated lesion. Neuronavigation-guided open surgery was performed but failed to find a malignancy. The patient presented 3 days later with sudden loss of consciousness, pupil dilation, and high fever. Emergent craniectomy was performed for severe right hemisphere swelling with midline shift. After craniectomy, pus was found in the previous operative field. Burkholderia pseudomallei was cultured from pus and blood samples 1 week after collection. The brain lesion developed into an organized abscess and led to mass effect and ventriculitis. Extraventricular drainage and débridement was performed repeatedly accompanied by systemic and intraventricular antibiotic administration. After 4 months of treatment, the patient achieved a complete consciousness recover while left hemiparesis. CONCLUSIONS CNS melioidosis requires accurate pathogen identification and appropriate long-term antibiotic treatment for eradication of bacteria and prevention of relapse. Débridement and adequate drainage provide better infection control and outcome.
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Vaid T, Rao K, Hande HM. An intriguing case of locked jaw secondary to melioidosis. BMJ Case Rep 2015; 2015:bcr-2015-213060. [PMID: 26628312 DOI: 10.1136/bcr-2015-213060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old woman presented with fever, pain and restriction of movement of the right temporomandibular joint. She was premorbidly diagnosed to have type 2 diabetes mellitus and rheumatoid arthritis. Local examination revealed a poorly demarcated severely tender, erythematous swelling in the right preauricular region. All haematological and biochemical investigations were within normal limits. MRI of the neck revealed the presence of a masticator space infection with intramuscular abscess involving the masseter and the temporalis muscles along with intracranial extension. Osteomyelitic changes were detected in the right mandibular condyle, temporal bone and in the temporomandibular joint. Melioidosis was suspected due to this unique clinical presentation of an abscess at an unusual and atypical site. Blood cultures identified the Gram-negative bacilli Burkholderia pseudomallei, which established the diagnosis of Melioidosis. Remarkable improvement was attained with antibiotics meropenem and cotrimoxazole, deferring the need for any surgical intervention.
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Affiliation(s)
- Tejasvini Vaid
- Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Karthik Rao
- Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India
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17
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Hsu CC, Singh D, Kwan G, Deuble M, Aquilina C, Korah I, Norton R. Neuromelioidosis: Craniospinal MRI Findings in Burkholderia pseudomallei Infection. J Neuroimaging 2015; 26:75-82. [PMID: 26256582 DOI: 10.1111/jon.12282] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate magnetic resonance imaging (MRI) findings of central nervous system (CNS) infection with Burkholderia pseudomallei. METHODS Retrospective analysis of 10 patients (5 male and 5 female, age range from 13 to 69 years) with CNS melioidosis confirmed on culture of blood, sputum, cerebrospinal fluid, brain biopsy, and postmortem brain tissue. Clinical data were collected and MRI brain and/or spine were independently reviewed. RESULTS Seven patients with brain parenchymal or intramedullary spinal cord lesions demonstrated rim-enhancing microabscesses with propensity for white matter tracts including the corticospinal tracts, corpus callosum, and cerebellar peduncles. Three of these 7 patients also showed thickening and enhancement of the trigeminal nerves with contiguous spread to brain stem trigeminal nuclei. Three patients had isolated extraaxial disease with findings including meningeal enhancement, extradural abscess, skull osteomyelitis, and scalp abscess. CONCLUSION 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.
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Affiliation(s)
- C C Hsu
- Department of Medical Imaging, Townsville Hospital, Townsville, Australia
| | - Dalveer Singh
- Department of Medical Imaging, Townsville Hospital, Townsville, Australia
| | - Gigi Kwan
- Department of Medical Imaging, Townsville Hospital, Townsville, Australia
| | - Martin Deuble
- Department of Microbiology and Pathology, The Townsville Hospital, Townsville, Australia
| | - Chloe Aquilina
- Department of Microbiology and Pathology, The Townsville Hospital, Townsville, Australia
| | - Ipeson Korah
- Department of Medical Imaging, Townsville Hospital, Townsville, Australia
| | - Robert Norton
- Department of Microbiology and Pathology, The Townsville Hospital, Townsville, Australia
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Liu PJ, Chen YS, Lin HH, Ni WF, Hsieh TH, Chen HT, Chen YL. Induction of mouse melioidosis with meningitis by CD11b+ phagocytic cells harboring intracellular B. pseudomallei as a Trojan horse. PLoS Negl Trop Dis 2013; 7:e2363. [PMID: 23951382 PMCID: PMC3738478 DOI: 10.1371/journal.pntd.0002363] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/30/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Approximately 3-5% of patients with melioidosis manifest CNS symptoms; however, the clinical data regarding neurological melioidosis are limited. METHODS AND FINDINGS We established a mouse model of melioidosis with meningitis characterized by neutrophil infiltration into the meninges histologically and B. pseudomallei in the cerebrospinal fluid (CSF) by bacteriological culturing methods. As the disease progresses, the bacteria successively colonize the spleen, liver, bone marrow (BM) and brain and invade splenic and BM cells by days 2 and 6 post-infection, respectively. The predominant cell types intracellularly infected with B. pseudomallei were splenic and BM CD11b(+) populations. The CD11b(+)Ly6C(high) inflamed monocytes, CD11b(+)Ly6C(low) resident monocytes, CD11b(+)Ly6G(+) neutrophils, CD11b(+)F4/80(+) macrophages and CD11b(+)CD19(+) B cells were expanded in the spleen and BM during the progression of melioidosis. After adoptive transfer of CD11b populations harboring B. pseudomallei, the infected CD11b(+) cells induced bacterial colonization in the brain, whereas CD11b(-) cells only partially induced colonization; extracellular (free) B. pseudomallei were unable to colonize the brain. CD62L (selectin) was absent on splenic CD11b(+) cells on day 4 but was expressed on day 10 post-infection. Adoptive transfer of CD11b(+) cells expressing CD62L (harvested on day 10 post-infection) resulted in meningitis in the recipients, but transfer of CD11b(+) CD62L-negative cells did not. CONCLUSIONS/SIGNIFICANCE We suggest that B. pseudomallei-infected CD11b(+) selectin-expressing cells act as a Trojan horse and are able to transmigrate across endothelial cells, resulting in melioidosis with meningitis.
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Affiliation(s)
- Pei-Ju Liu
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
- Graduate Institute of Environmental Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Hsi-Hsu Lin
- Department of Infectious Disease, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Wei-Feng Ni
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Tsung-Han Hsieh
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Hsu-Tzu Chen
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Ya-Lei Chen
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
- * E-mail:
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Vestal ML, Wong EB, Milner DA, Gormley WB, Dunn IF. Cerebral melioidosis for the first time in the western hemisphere. J Neurosurg 2013; 119:1591-5. [PMID: 23767895 DOI: 10.3171/2013.5.jns12555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This report is the first published case of cerebral melioidosis in the western hemisphere. In this paper the authors review the literature on neurological melioidosis and its presentation and treatment in endemic areas, describe the clinical course of this unique case of a presentation of the disease with cranial abscess in the US, review the pathological and radiological findings associated with this seminal case, and put forth recommendations for recognizing and treating possible future instances of the disease within the western hemisphere.
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Kung CT, Li CJ, Ko SF, Lee CH. A Melioidosis Patient Presenting with Brainstem Signs in the Emergency Department. J Emerg Med 2013; 44:e9-12. [DOI: 10.1016/j.jemermed.2011.05.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 01/11/2011] [Accepted: 05/28/2011] [Indexed: 11/29/2022]
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Melioidosis and the vacuum-assisted closure device: a rare cause of a discharging neck wound, and a new approach to management. The Journal of Laryngology & Otology 2010; 124:1021-4. [PMID: 20219147 DOI: 10.1017/s0022215110000381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We report a case of melioidosis presenting as a discharging neck abscess, and we describe the use of a vacuum-assisted closure device in its management. METHOD We report the case of a 44-year-old, Afro-Caribbean woman with melioidosis. We also present the results of a literature search using the search terms 'melioidosis', 'Burkholderia pseudomallei' and 'vacuum-assisted closure device'. RESULTS Microbiological analysis identified the causative organism as being the bacterium Burkholderia pseudomallei, and its antimicrobial sensitivities to imipenem and ciprofloxacin. A vacuum-assisted closure device was used to manage the patient's melioidosis of the neck; we believe this is the first report of such treatment. CONCLUSIONS Melioidosis is rare in the UK and western world; however, exposure can occur during travel to endemic areas. We therefore draw attention to this infection as part of the differential diagnosis of a neck abscess. We propose the use of vacuum-assisted closure devices as useful adjuncts to the management of discharging neck wounds.
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