1
|
Cote CK, Mlynek KD, Klimko CP, Biryukov SS, Mou S, Hunter M, Rill NO, Dankmeyer JL, Miller JA, Talyansky Y, Davies ML, Meinig JM, Halasohoris SA, Gray AM, Spencer JL, Babyak AL, Hourihan MK, Curry BJ, Toothman RG, Ruiz SI, Zeng X, Ricks KM, Clements TL, Douglas CE, Ravulapalli S, Stefan CP, Shoemaker CJ, Elrod MG, Gee JE, Weiner ZP, Qiu J, Bozue JA, Twenhafel NA, DeShazer D. Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray. Emerg Infect Dis 2024; 30:2056-2069. [PMID: 39320153 DOI: 10.3201/eid3010.240084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
In the United States in 2021, an outbreak of 4 cases of Burkholderia pseudomallei, the etiologic agent of melioidosis and a Tier One Select Agent (potential for deliberate misuse and subsequent harm), resulted in 2 deaths. The causative strain, B. pseudomallei ATS2021, was unintentionally imported into the United States in an aromatherapy spray manufactured in India. We established that ATS2021 represents a virulent strain of B. pseudomallei capable of robust formation of biofilm at physiologic temperatures that may contribute to virulence. By using mouse melioidosis models, we determined median lethal dose estimates and analyzed the bacteriologic and histopathologic characteristics of the organism, particularly the potential neurologic pathogenesis that is probably associated with the bimABm allele identified in B. pseudomallei strain ATS2021. Our data, combined with previous case reports and the identification of endemic B. pseudomallei strains in Mississippi, support the concept that melioidosis is emerging in the United States.
Collapse
|
2
|
T AM, Singh B, Rupali P. Central nervous system infections in the tropics. Curr Opin Infect Dis 2024; 37:201-210. [PMID: 38529912 DOI: 10.1097/qco.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Emerging and re-emerging central nervous system (CNS) infections are a major public health concern in the tropics. The reasons for this are myriad; climate change, rainfall, deforestation, increased vector density combined with poverty, poor sanitation and hygiene. This review focuses on pathogens, which have emerged and re-emerged, with the potential for significant morbidity and mortality. RECENT FINDINGS In recent years, multiple acute encephalitis outbreaks have been caused by Nipah virus, which carries a high case fatality. Arboviral infections, predominantly dengue, chikungunya and Zika are re-emerging increasingly especially in urban areas due to changing human habitats, vector behaviour and viral evolution. Scrub typhus, another vector borne disease caused by the bacterium Orientia tsutsugamushi , is being established as a leading cause of CNS infections in the tropics. SUMMARY A syndromic and epidemiological approach to CNS infections in the tropics is essential to plan appropriate diagnostic tests and management. Rapid diagnostic tests facilitate early diagnosis and thus help prompt initiation and focusing of therapy to prevent adverse outcomes. Vector control, cautious urbanization and deforestation, and reducing disturbance of ecosystems can help prevent spread of vector-borne diseases. Regional diagnostic and treatment approaches and specific vaccines are required to avert morbidity and mortality.
Collapse
Affiliation(s)
| | - Bhagteshwar Singh
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Institute of Infection Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Infectious Diseases
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Corbisiero MF, Ripperton RA, Creighton EG, Smyth AM, Beckham JD, Henao-Martínez AF. Brain Abscesses in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2023; 10:235-243. [PMID: 38947183 PMCID: PMC11212790 DOI: 10.1007/s40475-023-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 07/02/2024]
Abstract
Purpose of Review This review aims to elucidate the etiologies of brain abscesses in the tropics. Despite the similarities in causes of brain abscesses across global regions, tropical settings manifest distinguishing characteristics, prominently observed on computed tomography or magnetic resonance imaging. Recent Findings In tropical climates, the leading conditions predisposing individuals to brain abscesses are polymicrobial bacterial infections originating from paranasal sinuses, dental sources, and otitis media. However, the tropics present unique etiologies to be aware of, including Trypanosoma cruzi (Chagas disease), free-living amoebas like Balamuthia mandrillaris, infections from Burkholderia pseudomallei (melioidosis), fungi such as Talaromyces marneffei, and Mycobacterium tuberculosis. Given the differential diagnoses, which include neoplastic, inflammatory, and demyelinating diseases, a stereotactic biopsy coupled with a microbiological assessment remains valuable for accurate diagnosis. Summary In tropical regions, brain abscesses are a concern when confronted with mass-occupying or other types of brain lesions. Successful clinical management of brain abscesses typically combines surgical intervention and extended anti-microbial treatment. However, specific parasitic invasions like Chagas disease, free-living amoebas, and Entamoeba histolytica necessitate targeted anti-parasitic therapies. Furthermore, international policy efforts should focus on prevention measures in resource limited regions with heightened risks and disease burden.
Collapse
Affiliation(s)
| | | | | | | | - J. David Beckham
- Division of Infectious Diseases and Geographic Medicine, Southwestern Medical Center, UT, Dallas, TX, USA
| | - Andres F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Denver, CO, USA
| |
Collapse
|
5
|
Datta D, Sekar A, Patnaik A, Mohanty S. A Case-Based Review of Management of CNS Melioidosis. Asian J Neurosurg 2023; 18:836-838. [PMID: 38161600 PMCID: PMC10756835 DOI: 10.1055/s-0043-1776736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Debajyoti Datta
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arunkumar Sekar
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashis Patnaik
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
6
|
Lohitthai S, Rungruengkitkun A, Jitprasutwit N, Kong-Ngoen T, Duangurai T, Tandhavanant S, Sukphopetch P, Chantratita N, Indrawattana N, Pumirat P. Type VI Secretion System Accessory Protein TagAB-5 Promotes Burkholderia pseudomallei Pathogenicity in Human Microglia. Biomedicines 2023; 11:2927. [PMID: 38001928 PMCID: PMC10669256 DOI: 10.3390/biomedicines11112927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Central nervous system (CNS) melioidosis caused by Burkholderia pseudomallei is being increasingly reported. Because of the high mortality associated with CNS melioidosis, understanding the underlying mechanism of B. pseudomallei pathogenesis in the CNS needs to be intensively investigated to develop better therapeutic strategies against this deadly disease. The type VI secretion system (T6SS) is a multiprotein machine that uses a spring-like mechanism to inject effectors into target cells to benefit the infection process. In this study, the role of the T6SS accessory protein TagAB-5 in B. pseudomallei pathogenicity was examined using the human microglial cell line HCM3, a unique resident immune cell of the CNS acting as a primary mediator of inflammation. We constructed B. pseudomallei tagAB-5 mutant and complementary strains by the markerless allele replacement method. The effects of tagAB-5 deletion on the pathogenicity of B. pseudomallei were studied by bacterial infection assays of HCM3 cells. Compared with the wild type, the tagAB-5 mutant exhibited defective pathogenic abilities in intracellular replication, multinucleated giant cell formation, and induction of cell damage. Additionally, infection by the tagAB-5 mutant elicited a decreased production of interleukin 8 (IL-8) in HCM3, suggesting that efficient pathogenicity of B. pseudomallei is required for IL-8 production in microglia. However, no significant differences in virulence in the Galleria mellonella model were observed between the tagAB-5 mutant and the wild type. Taken together, this study indicated that microglia might be an important intracellular niche for B. pseudomallei, particularly in CNS infection, and TagAB-5 confers B. pseudomallei pathogenicity in these cells.
Collapse
Affiliation(s)
- Sanisa Lohitthai
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| | - Amporn Rungruengkitkun
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| | - Niramol Jitprasutwit
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - Thida Kong-Ngoen
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| | - Taksaon Duangurai
- Department of Companion Animal Clinical Sciences, Kasetsart University, Bangkok 10900, Thailand;
| | - Sarunporn Tandhavanant
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
- Department of Bacteriology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Nitaya Indrawattana
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| | - Pornpan Pumirat
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (S.L.); (A.R.); (T.K.-N.); (S.T.); (P.S.); (N.C.); (N.I.)
| |
Collapse
|
7
|
Jitprasutwit N, Rungruengkitkun A, Lohitthai S, Reamtong O, Indrawattana N, Sookrung N, Sricharunrat T, Sukphopetch P, Chatratita N, Pumirat P. In Vitro Roles of Burkholderia Intracellular Motility A (BimA) in Infection of Human Neuroblastoma Cell Line. Microbiol Spectr 2023; 11:e0132023. [PMID: 37409935 PMCID: PMC10434047 DOI: 10.1128/spectrum.01320-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
The bacterial pathogen Burkholderia pseudomallei causes human melioidosis, which can infect the brain, leading to encephalitis and brain abscesses. Infection of the nervous system is a rare condition but is associated with an increased risk of mortality. Burkholderia intracellular motility A (BimA) was reported to play an important role in the invasion and infection of the central nervous system in a mouse model. Thus, to gain insight of the cellular mechanisms underlying the pathogenesis of neurological melioidosis, we explored the human neuronal proteomics to identify the host factors that are up- and downregulated during Burkholderia infection. When infected the SH-SY5Y cells with B. pseudomallei K96243 wild-type (WT), 194 host proteins showed a fold change of >2 compared with uninfected cells. Moreover, 123 proteins showed a fold change of >2 when infected with a knockout bimA mutant (ΔbimA) mutant compared with WT. The differentially expressed proteins were mainly associated with metabolic pathways and pathways linked to human diseases. Importantly, we observed the downregulation of proteins in the apoptosis and cytotoxicity pathway, and in vitro investigation with the ΔbimA mutant revealed the association of BimA with the induction of these pathways. Additionally, we disclosed that BimA was not required for invasion into the neuron cell line but was necessary for effective intracellular replication and multinucleated giant cell (MNGC) formation. These findings show the extraordinary capacity of B. pseudomallei in subverting and interfering with host cellular systems to establish infection and extend our understanding of B. pseudomallei BimA involvement in the pathogenesis of neurological melioidosis. IMPORTANCE Neurological melioidosis, caused by Burkholderia pseudomallei, can result in severe neurological damage and enhance the mortality rate of melioidosis patients. We investigate the involvement of the virulent factor BimA, which mediates actin-based motility, in the intracellular infection of neuroblastoma SH-SY5Y cells. Using proteomics-based analysis, we provide a list of host factors exploited by B. pseudomallei. The expression level of selected downregulated proteins in neuron cells infected with the ΔbimA mutant was determined by quantitative reverse transcription-PCR and was consistent with our proteomic data. The role of BimA in the apoptosis and cytotoxicity of SH-SY5Y cells infected by B. pseudomallei was uncovered in this study. Additionally, our research demonstrates that BimA is required for successful intracellular survival and cell fusion upon infection of neuron cells. Our findings have significant implications for understanding the pathogenesis of B. pseudomallei infections and developing novel therapeutic strategies to combat this deadly disease.
Collapse
Affiliation(s)
- Niramol Jitprasutwit
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Amporn Rungruengkitkun
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sanisa Lohitthai
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Onrapak Reamtong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nitaya Indrawattana
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nitat Sookrung
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Biomedical Research Incubator Unit, Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thaniya Sricharunrat
- Pathology and Forensic Science Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narisara Chatratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornpan Pumirat
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
8
|
Keragala KARK, Gunathilaka MGRSS, Senevirathna RMISK, Jayaweera JAAS. Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review. Ann Clin Microbiol Antimicrob 2023; 22:74. [PMID: 37592339 PMCID: PMC10436656 DOI: 10.1186/s12941-023-00620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei. The two stages of melioidosis treatment are the intense intravenous phase and the oral eradication phase. Although co-trimoxazole has been in use for several years, the literature does not demonstrate uniformity of the drug doses, combinations, or durations suitable for the eradication phase of melioidosis. The safety profile of co-trimoxazole was not documented in the literature, nor have systematic studies of its effectiveness been done. This systematic review sought to study on the dose, duration and combination of co-trimoxazole therapy in view of clinical efficacy and safety in the eradication phase of melioidosis. MAIN BODY This systematic review included all of the published articles that employed co-trimoxazole in the eradication phase after 1989, including, randomized clinical trials, case-control studies, cohorts, case reports, and case series. Throughout the eradication (maintenance) phase, co-trimoxazole usage was permissible in any dose for any period. A total of 40 results were included in the analysis which contained six clinical trials, one cohort study, one Cochrane review, and thirty-two case series/case reports. Clinical and microbial relapse rates are low when co-trimoxazole is used in single therapy than in combination. There were several adverse events of co-trimoxazole, however, a quantitative analysis was not conducted as the data did not include quantitative values in most studies. SHORT CONCLUSION The dose of co-trimoxazole, duration of the eradication phase, and other combinations used in the treatment was varying between studies. Compared to combined therapy patients treated with co-trimoxazole alone the mortality and relapse rates were low. The lowest relapse rate and lowest mortality rate occur when using co-trimoxazole 1920 mg twice daily. The duration of therapy varies on the focus of melioidosis and it is ranged from 2 months to one year and minimum treatment duration associated with low relapse rate is 3 months. The use of co-trimoxazole over the maintenance phase of melioidosis is associated with clinical cure but has adverse effects.
Collapse
|
9
|
Chandra K, Rajesh BJ. Concomitant extradural, subdural, and intraparenchymal abscesses of the brain in a patient with cerebral melioidosis - A case report. Surg Neurol Int 2022; 13:588. [PMID: 36600733 PMCID: PMC9805620 DOI: 10.25259/sni_861_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Extra axial abscess of the brain is a rare entity, moreover, extra-axial abscess concomitant with intraparenchymal purulent collections are scarcely reported in the literature. Etiology includes penetrating trauma, paranasal sinusitis, mastoiditis, craniospinal surgeries, and the rare spread of infectious agents through the hematogenous route. Case description We present a case of a young male with Burkholderia pseudomallei Central Nervous System (CNS) melioidosis, forming abscesses in extra-axial and intraparenchymal planes without contiguity. Conclusion This is to emphasize the importance of MR spectroscopy and other convenient methods in differentiating the etiology in cranial infections.
Collapse
Affiliation(s)
- Kartik Chandra
- Corresponding author: Kartik Chandra, Resident, Department of Neurosurgery, Yashoda Hospitals, Hyderabad, Telangana, India.
| | | |
Collapse
|
10
|
Yang CWR, Mason M, Parizel PM, Warne R. Magnetic resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. Insights Imaging 2022; 13:160. [PMID: 36194350 PMCID: PMC9532482 DOI: 10.1186/s13244-022-01298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022] Open
Abstract
Paediatric brain infections are relatively uncommon, but it is important for radiologists to recognise the disease and provide accurate differential diagnoses. Magnetic resonance imaging (MRI) plays an important role in determining the most likely causative pathogen—either in the setting of an unwell child with acute infectious encephalitis, or in the evaluation of a child for sequela of prior infection. Image analysis can, however, be difficult since a particular pathogen can cause variable MRI findings across different geographic environments, and conversely, a particular appearance on MRI may be caused by a variety of pathogens. This educational review aims to identify some of the key MRI patterns seen in paediatric brain infections and present example cases encountered in Western Australia. Based on (i) the predominant type of signal abnormality (restricted diffusion versus T2 hyperintensity) and (ii) the distribution of signal abnormality throughout the brain, this review presents a framework of six key MRI patterns seen in paediatric brain infections, with an emphasis on acute infectious encephalitis. There is general utility to these MRI patterns—each suggestive of a group of likely diagnostic possibilities which can be calibrated according to institution and local environment. The pattern-based framework of this review can be easily transitioned into daily radiological practice, and we hope it facilitates the formation of accurate differential diagnoses in paediatric brain infections.
Collapse
Affiliation(s)
- Chi-Wei Robin Yang
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Paul M Parizel
- Department of Radiology, University of Western Australia (UWA), Royal Perth Hospital (RPH), Perth, WA, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Sharma A, Mahajan Z, Madhyastha SP, Mehta V. Critical approach to atypical spectrum of melioidosis: a case-series based literature review. BMJ Case Rep 2022; 15:e249417. [PMID: 35667698 PMCID: PMC9171171 DOI: 10.1136/bcr-2022-249417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Akhya Sharma
- Internal Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Zubin Mahajan
- Internal Medicine, Loyola Medicine MacNeal Hospital, Berwyn, Illinois, India
| | - Sharath P Madhyastha
- Internal Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Vishal Mehta
- Internal Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India
| |
Collapse
|
13
|
Clinical Burkholderia pseudomallei isolates from north Queensland carry diverse bimABm genes that are associated with central nervous system disease and are phylogenomically distinct from other Australian strains. PLoS Negl Trop Dis 2022; 16:e0009482. [PMID: 35700198 PMCID: PMC9236262 DOI: 10.1371/journal.pntd.0009482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/27/2022] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Burkholderia pseudomallei is an environmental gram-negative bacterium that causes the disease melioidosis and is endemic in many countries of the Asia-Pacific region. In Australia, the mortality rate remains high at approximately 10%, despite curative antibiotic treatment being available. The bacterium is almost exclusively found in the endemic region, which spans the tropical Northern Territory and North Queensland, with clusters occasionally present in more temperate climates. Despite being endemic to North Queensland, these infections remain understudied compared to those of the Northern Territory. Methodology/Principal findings This study aimed to assess the prevalence of central nervous system (CNS) disease associated variant bimABm, identify circulating antimicrobial resistance mutations and genetically distinct strains from Queensland, via comparative genomics. From 76 clinical isolates, we identified the bimABm variant in 20 (26.3%) isolates and in 9 (45%) of the isolates with documented CNS infection (n = 18). Explorative analysis suggests a significant association between isolates carrying the bimABm variant and CNS disease (OR 2.8, 95% CI 1.3–6.0, P = 0.009) compared with isolates carrying the wildtype bimABp. Furthermore, 50% of isolates were identified as novel multi-locus sequence types, while the bimABm variant was more commonly identified in isolates with novel sequence types, compared to those with previously described. Additionally, mutations associated with acquired antimicrobial resistance were only identified in 14.5% of all genomes. Conclusions/Significance The findings of this research have provided clinically relevant genomic data of B. pseudomallei in Queensland and suggest that the bimABm variant may enable risk stratification for the development CNS complications and be a potential therapeutic target. Melioidosis is a life-threatening infection, caused by the Gram-negative bacterium Burkholderia pseudomallei, which is endemic to tropical regions in Australia. Variants of the bimA gene have been proposed as a virulence factor associated with more severe disease. In a genomic analysis of 76 clinical B. pseudomallei isolates from Queensland, Australia, we identified that the bimABm variant was associated with infection involving the central nervous system (odds ratio 2.8, 95% Confidence Interval: 1.3–6.0, P = 0.009), compared to isolates with the wild-type allele bimABp. Half of the isolates from this region were novel multi-locus sequence types, and bimABm was more commonly seen in these novel sequence types. Early genomic characterisation to identify virulence factors such as bimABm, may be useful as an early marker of more complex disease that could guide further investigation and help determine optimal treatment. Further investigation of a “genomics-guided” approach to the clinical management of this complex infectious disease are warranted.
Collapse
|
14
|
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.
Collapse
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
| | | |
Collapse
|
15
|
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
| |
Collapse
|
16
|
Gora H, Hasan T, Smith S, Wilson I, Mayo M, Woerle C, Webb JR, Currie BJ, Hanson J, Meumann EM. Melioidosis of the central nervous system; impact of the bimABm allele on patient presentation and outcome. Clin Infect Dis 2022:ciac111. [PMID: 35137005 DOI: 10.1093/cid/ciac111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The autotransporter protein Burkholderia intracellular motility A (BimA) facilitates the entry of Burkholderia pseudomallei into the central nervous system (CNS) in mouse models of melioidosis. Its role in the pathogenesis of human cases of CNS melioidosis is incompletely defined. METHODS Consecutive culture-confirmed cases of melioidosis at two sites in tropical Australia after 1989 were reviewed. Demographic, clinical and radiological data of the patients with CNS melioidosis were recorded. The bimA allele (bimABm or bimABp) of the B. pseudomallei isolated from each patient was determined. RESULTS Of the 1587 cases diagnosed at the two sites during the study period, 52 (3.3%) had confirmed CNS melioidosis; 20 (38.5%) had a brain abscess, 18 (34.6%) had encephalomyelitis, 4 (7.7%) had isolated meningitis and 10 (19.2%) had extra-meningeal disease. Among the 52 patients, there were 8 (15.4%) deaths; 17/44 (38.6%) survivors had residual disability. The bimA allele was characterized in 47/52; 17/47 (36.2%) had the bimABm allele and 30 (63.8%) had the bimABp allele. Patients with a bimABm variant were more likely to have a predominantly neurological presentation (odds ratio (OR) (95% confidence interval (CI)): 5.60 (1.52-20.61), p=0.01), to have brainstem involvement (OR (95%CI): 7.33 (1.92-27.95), p=0.004) and to have encephalomyelitis (OR (95%CI): 4.69 (1.30-16.95), p=0.02. Patients with a bimABm variant were more likely to die or have residual disability (odds ratio (95%CI): 4.88 (1.28-18.57), p=0.01). CONCLUSIONS The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis.
Collapse
Affiliation(s)
- Hannah Gora
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Tasnim Hasan
- Centre for Disease Control, Northern Territory Top End Health Services, Darwin, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Ian Wilson
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Mark Mayo
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Celeste Woerle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jessica R Webb
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- The Kirby Institute, University of New South Wales, Kensington, Australia
| | - Ella M Meumann
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Jabeen S, Saini J, Mishra T, Mailankody P, Ts L, Chandrashekar N. Neuromelioidosis Presenting as a Stroke-like Syndrome. Neurol Clin Pract 2021; 11:e589-e591. [PMID: 34484969 DOI: 10.1212/cpj.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Shumyla Jabeen
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tanaya Mishra
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pooja Mailankody
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lingaraju Ts
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nagarathna Chandrashekar
- Department of Neuroimaging and interventional Radiology (SJ, JS); Department of Neurology (TM, PM); Department of Neurosurgery (LTS); and Department of Neuromicrobiology (NC), National Institute of Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
19
|
Zamzuri M’AIA, Jamhari MN, Nawi HM, Hassan MR, Pang NTP, Kassim MAM, Rahim SSSA, Jeffree MS, Lee SY. Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years.
Method: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015-2019.
Results: Central nervous system (CNS) complications comprise 5% of all cases of melioidosis. 16 selected articles were analysed based on its risk factors like diabetes mellitus, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is detected 6-14 days after the first presentation and confirmed by detailed investigations. Radioimaging helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 2-week intensive Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole oral eradication therapy.
Conclusion: Neuromelioidosis is rare, with relatively nonspecific CNS clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radioimaging modalities aid early microbiological sampling and appropriate antibiotic therapy.
Collapse
|
20
|
Cheok LH, Tang ASO, Desmond S, Wong YL, Cheong YK, Ng SC, Cheng WM, Chua HH, Teh CL. Central nervous system melioidosis in systemic lupus erythematosus: A clinical vignette. IDCases 2021; 26:e01255. [PMID: 34458097 PMCID: PMC8377557 DOI: 10.1016/j.idcr.2021.e01255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
A case of a disseminated melioidosis infection with central nervous system, pulmonary, spleen, bone and skin involvement. Central nervous system melioidosis in a patient with underlying systemic lupus erythematosus. Agriculture contact and underlying immunocompromised state predispose to melioidosis infection. Positive cerebrospinal fluid cultures to confirm central nervous system melioidosis. Extension of eradication therapy in view of osteomyelitis and residual cerebral lesion.
Central nervous system melioidosis is an uncommon presentation of melioidosis infection. We report a case of a disseminated melioidosis infection with central nervous system, pulmonary, spleen, bone and cutaneous involvement in a patient with underlying systemic lupus erythematous. The diagnosis was confirmed based on positive blood and cerebrospinal fluid cultures coupled with radiological findings. Agriculture contact and underlying immunocompromised state were the predisposing risk factors for melioidosis infection in this case. Our patient was successfully treated with 10 weeks of intensive antibiotics therapy and 1 year of eradication antibiotics therapy with significant clinical and radiological improvement.
Collapse
Affiliation(s)
- Lay Hock Cheok
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Andy Sing Ong Tang
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Samuel Desmond
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Yi-Li Wong
- Department of Radiology, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Yaw Kiet Cheong
- Rheumatology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
| | - Say Chiew Ng
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Wee Mee Cheng
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Hock Hin Chua
- Infectious Disease Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
| | - Cheng Lay Teh
- Rheumatology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
| |
Collapse
|
21
|
Mannam P, Arvind VH, Koshy M, Varghese GM, Alexander M, Elizabeth SM. Neuromelioidosis: A Single-Center Experience with Emphasis on Imaging. Indian J Radiol Imaging 2021; 31:57-64. [PMID: 34316112 PMCID: PMC8299505 DOI: 10.1055/s-0041-1729125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction
Infection with
Burkholderia pseudomallei
, a gram-negative bacterium found in soil and surface water, is termed melioidosis and is commonly reported to occur in Southeast Asia and Northern Australia, where it is endemic. It is being increasingly reported in India, and transmission occurs through inhalation, inoculation, and ingestion. The neuroparenchyma, the adjacent soft tissue, and bone are known to be affected in both the acute and chronic disease forms. Involvement of these structures is rare but causes significant mortality and morbidity.
Material and Methods
Eighteen culture-proven cases of neuromelioidosis were identified between January 2008 and December 2019. The patients were retrospectively identified via search of the hospital’s electronic database.
Results
Cranial disease was in the form of parenchymal abscesses (
n
= 4), cerebritis/encephalitis (
n
= 5), and extradural (
n
= 4) and dural disease (
n
= 1). Acute myelitis (
n
= 1) and spondylodiscitis (
n
= 3) were seen in the spinal disease form. Neuroparenchymal involvement ranged from cerebritis/encephalitis to early and mature parenchymal abscesses. Extradural involvement was in the form of extradural abscesses and/or thick irregular enhancement in the extradural region. Early diagnosis and initiation of appropriate therapy had favorable outcomes in 15 out of 18 patients. Two patients with parenchymal abscesses and one with myelitis succumbed to the illness.
Conclusion
Neuromelioidosis is a rare manifestation of melioidosis with significant morbidity and mortality, necessitating a high index of clinical suspicion, especially if there has been travel to endemic regions. Imaging plays a key role in facilitating early diagnosis and initiation of therapy.
Collapse
Affiliation(s)
- Pavithra Mannam
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vanjare H Arvind
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi M Elizabeth
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
22
|
Ganesan V, Murugan M, Sundaramurthy R, Soundaram GV. Melioidosis in a Tertiary Care Center from South India: A 5-year Experience. Indian J Crit Care Med 2021; 25:327-330. [PMID: 33790516 PMCID: PMC7991756 DOI: 10.5005/jp-journals-10071-23766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study was done with the objective to know the clinical presentation, microbiological features, and treatment outcome of melioidosis patients in our hospital, which is an emerging infection in India, and to know the differences in clinical course and outcome between bacteremic and nonbacteremic patients. This retrospective observational study was carried out over a period of 5 years from January 2015 to December 2019. Thirty-five cases of culture-confirmed melioidosis were identified with age range between 5 and 74 years. A large number of patients (n = 31) presented with uncontrolled diabetes mellitus. Six patients died of septic shock, and the outcome of eight patients was unknown as they were discharged against medical advice. There were no relapses observed. Melioidosis growing as a neglected tropical disease in India warrants awareness among all clinicians across the country. How to cite this article: Ganesan V, Murugan M, Sundaramurthy R, Soundaram GVG. Melioidosis in a Tertiary Care Center from South India: A 5-year Experience. Indian J Crit Care Med 2021;25(3):327–330.
Collapse
Affiliation(s)
- Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Mariappan Murugan
- Department of Radiodiagnosis, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Raja Sundaramurthy
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Geni Vg Soundaram
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| |
Collapse
|
23
|
Mishra B, Vishnu VY, Bhatia R, Garg A, Doddamani RS, Singh P, Chand Sharma M, Singh MB, Rajan R, Gupta A, Srivastava MVP. Case Report: Isolated Central Nervous System Melioidosis from a Non-Endemic Area. Am J Trop Med Hyg 2021; 104:1247-1251. [PMID: 33432911 DOI: 10.4269/ajtmh.20-1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/25/2020] [Indexed: 11/07/2022] Open
Abstract
Central nervous system (CNS) melioidosis is a rare neurological infectious disease which carries a high mortality. We describe a previously healthy middle-aged female, who presented to us with left-sided hemiparesis and was on antitubercular therapy from a previous presumed diagnosis of CNS tuberculoma. Non-characteristic imaging picture, multiple negative body fluid cultures, and positive Cerebrospinal fluid galactomannan led to a further delay in diagnosis. Gram stain of the tissue obtained from brain biopsy revealed Gram-negative rods in "safety pin" appearance. By picking up the colonies that appeared on blood agar and MacConkey agar, the identification of the clinical isolates was performed using VITEK® matrix (BioMerieux)-assisted laser desorption ionization time-of-flight mass spectrometry (VITEK MALDI TOF MS database version 3.2) which revealed Burkholderia pseudomallei. After the institution of appropriate treatment, she survived but with significant morbidity. A high index of suspicion should be kept for such previously healthy individuals belonging to non-endemic areas, where presentation is suspicious of an infective etiology, but not improving despite appropriate therapy. This may help in early recognition and institution of recommended treatment so that mortality can be avoided.
Collapse
Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Parul Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of NeuroPathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
24
|
Owen W, Smith S, Kuruvath S, Anderson D, Hanson J. Melioidosis of the central nervous system; A potentially lethal impersonator. IDCases 2020; 23:e01015. [PMID: 33304815 PMCID: PMC7708931 DOI: 10.1016/j.idcr.2020.e01015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
A 57-year-old Australian woman, with a history of hazardous alcohol consumption, presented with a seizure following 2 days of fever and headache. Initial imaging suggested the presence of an isolated brain abscess, however, a thorough physical examination, identified no additional septic focus. Five sets of blood cultures were sterile and serology for Burkholderia pseudomallei was negative. Other investigations including computed tomography of her chest, abdomen and pelvis and a trans-esophageal echocardiogram were normal. Despite the administration of intravenous vancomycin, ceftriaxone, and metronidazole, her condition deteriorated. At emergency craniotomy, the abscess was drained and B. pseudomallei was cultured, confirming a diagnosis of melioidosis. She received 8 weeks of intravenous meropenem, combined with oral trimethoprim/sulfamethoxazole; the trimethoprim/sulfamethoxazole was continued for a total of 12 months. She recovered completely and was able to return to full-time work. Melioidosis, is endemic to Australia and South East Asia and, globally, is estimated to kill 89,000 every year. It can affect almost any organ, but up to 5% have central nervous system (CNS) involvement, where it may present as an encephalomyelitis, brain abscess or meningitis. B. pseudomallei is resistant to many commonly used antibiotics and even in well-resourced settings the case-fatality rate of CNS infection may rise to 50 %. This patient lived in a melioid-endemic region, and, with hazardous alcohol consumption, had a classical risk factor for the disease, but the sterile blood cultures and negative B. pseudomallei serology delayed definitive therapy. Despite the delayed diagnosis, definitive drainage and prolonged anti-bacterial therapy ensured a complete recovery.
Collapse
Affiliation(s)
- William Owen
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Sarin Kuruvath
- Department of Neurosurgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - David Anderson
- Department of Neurosurgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
25
|
Nagendra S, Shah AG. Neuromeliodosis-A Tropical Illness Presenting as Meningoencephalitis with Unusual Brain Imaging. Ann Indian Acad Neurol 2020; 24:97-98. [PMID: 33911394 PMCID: PMC8061521 DOI: 10.4103/aian.aian_157_20] [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: 03/06/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shashank Nagendra
- Department of Neurology, Grant Medical College and Sir JJ Hospital, Mumbai, Maharashtra, India
| | - Arjun Gaurang Shah
- Department of Neurology, Grant Medical College and Sir JJ Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
26
|
Abstract
The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.
Collapse
Affiliation(s)
- I Gassiep
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Armstrong
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
| | - R Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Walkden H, Delbaz A, Nazareth L, Batzloff M, Shelper T, Beacham IR, Chacko A, Shah M, Beagley KW, Tello Velasquez J, St John JA, Ekberg JAK. Burkholderia pseudomallei invades the olfactory nerve and bulb after epithelial injury in mice and causes the formation of multinucleated giant glial cells in vitro. PLoS Negl Trop Dis 2020; 14:e0008017. [PMID: 31978058 PMCID: PMC7002012 DOI: 10.1371/journal.pntd.0008017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/05/2020] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
The infectious disease melioidosis is caused by the bacterium Burkholderia pseudomallei. Melioidosis is characterised by high mortality and morbidity and can involve the central nervous system (CNS). We have previously discovered that B. pseudomallei can infect the CNS via the olfactory and trigeminal nerves in mice. We have shown that the nerve path is dependent on mouse strain, with outbred mice showing resistance to olfactory nerve infection. Damage to the nasal epithelium by environmental factors is common, and we hypothesised that injury to the olfactory epithelium may increase the vulnerability of the olfactory nerve to microbial insult. We therefore investigated this, using outbred mice that were intranasally inoculated with B. pseudomallei, with or without methimazole-induced injury to the olfactory neuroepithelium. Methimazole-mediated injury resulted in increased B. pseudomallei invasion of the olfactory epithelium, and only in pre-injured animals were bacteria found in the olfactory nerve and bulb. In vitro assays demonstrated that B. pseudomallei readily infected glial cells isolated from the olfactory and trigeminal nerves (olfactory ensheathing cells and trigeminal Schwann cells, respectively). Bacteria were degraded by some cells but persisted in other cells, which led to the formation of multinucleated giant cells (MNGCs), with olfactory ensheathing cells less likely to form MNGCs than Schwann cells. Double Cap mutant bacteria, lacking the protein BimA, did not form MNGCs. These data suggest that injuries to the olfactory epithelium expose the primary olfactory nervous system to bacterial invasion, which can then result in CNS infection with potential pathogenic consequences for the glial cells.
Collapse
Affiliation(s)
- Heidi Walkden
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Ali Delbaz
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Lynn Nazareth
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Michael Batzloff
- Institute for Glycomics, Griffith University, Southport, Australia
| | - Todd Shelper
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Ifor R. Beacham
- Institute for Glycomics, Griffith University, Southport, Australia
| | - Anu Chacko
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Megha Shah
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
| | - Kenneth W. Beagley
- Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - James A. St John
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Australia
| | - Jenny A. K. Ekberg
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, Australia
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Australia
| |
Collapse
|