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Neurological melioidosis.

B J Currie1, D A Fisher, D M Howard

  • 1Division of Medicine, Royal Darwin Hospital Clinical School and Tropical Medicine and International Health Unit, Menzies School of Health Research, Casuarina, NT, Australia. bart@menzies.edu.au

Acta Tropica
|February 16, 2000
PubMed
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Central nervous system (CNS) melioidosis, caused by Burkholderia pseudomallei, is uncommon in humans but can lead to severe neurological issues. Direct organism spread, not just toxins, is likely responsible for CNS melioidosis.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Microbiology

Background:

  • Neurological abnormalities are known in animals with melioidosis.
  • Central nervous system (CNS) melioidosis is rare in humans but can manifest as brain abscesses or encephalitis.
  • A recent syndrome of meningoencephalitis involving the brainstem, cerebellum, and spinal cord has been recognized.

Purpose of the Study:

  • To document and analyze cases of CNS melioidosis.
  • To investigate the clinical features, diagnostic findings, and outcomes of CNS melioidosis.
  • To explore the potential mechanisms of CNS involvement in melioidosis.

Main Methods:

  • Prospective study of melioidosis cases at Royal Darwin Hospital over 9 years.
  • Clinical data collection, including neurological presentations and outcomes.

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  • Diagnostic investigations including CT/MRI scans and cerebrospinal fluid (CSF) analysis.
  • Bacterial culture from CSF and autopsy tissues.
  • Preliminary molecular typing of Burkholderia pseudomallei isolates.

    • Main Results:

    • 12 cases of CNS melioidosis identified out of 232 total melioidosis cases (5%).
    • Common presentations included unilateral limb weakness, cerebellar and brainstem signs, and flaccid paraparesis.
    • High rates of cranial nerve palsies (VIIth nerve and bulbar) were observed, with some requiring prolonged ventilation.
    • Initial CT scans were often normal, while MRI showed significant changes.
    • Mortality was high (3/12), with only 3 full recoveries.
    • Burkholderia pseudomallei was cultured from CSF in two cases, and necrotizing encephalitis with microabscesses was found on autopsy in one.

    Conclusions:

    • Direct spread of Burkholderia pseudomallei within the CNS is likely the primary cause of CNS melioidosis, rather than a neurotropic exotoxin.
    • CNS melioidosis presents with diverse neurological deficits and has a significant mortality rate.
    • Further research is needed to understand the epidemiology and potential regional variations in CNS melioidosis incidence.