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In Vivo Imaging Systems (IVIS) Detection of a Neuro-Invasive Encephalitic Virus
Published on: December 2, 2012
Imaging in Neuro-Melioidosis: Lessons from a Multi-centre Collaborative Effort Across India
Sabha Ahmed1, Ankit Arora1, Srinivas Meharwade1
1From the Department of Neuroimaging and Interventional Radiology (S.A., A.A., S. M., A.K., S.B.S., S.T.), Neuropathology (A.M.), Neurology (G.V.H., S.D.V., N.M.), Professor, Department of Neuroimaging and Interventional Radiology (J.S., M.D.B.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India; Director and Professor at Barnard Institute of Radiology (B.P.S.), Madras Medical College, Chennai, Tamil Nadu, India; Department of Radiology (S.R. K., S.K.D., S.R.K.), Neurology (R.N., T.M.), St John's Medical College Hospital, Bengaluru, Karnataka, India; Department of Neuroradiology (U.V.A.), Manipal Hospitals, Bengaluru, Karnataka, India; Department of Neurology (J.A.), Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India; Department of Radiology (R.S.C., N.K.), General Medicine (J.S.), AIIMS Raipur, Raipur, Chhattisgarh, India; Department of Neurology (S.L.B.), Bangalore Hospitals, Bangalore, India and Department of Radiology (G.B.), Mayo Clinic, Rochester, Minnesota, USA.
Background And Purpose:
Neuro-melioidosis is an uncommon but potentially fatal manifestation of Burkholderia pseudomallei infection with diverse and often under-recognized imaging features. Existing imaging literature is limited to isolated reports and small series. We aimed to characterize the craniospinal MRI spectrum of neuro-melioidosis in a multicentre Indian cohort and identify recurrent imaging patterns associated with diagnostic delay.
Materials And Methods:
In this retrospective multicentre case series, 33 patients with microbiologically confirmed neuro-melioidosis from seven Indian tertiary centres (2019-2025) underwent systematic neuroimaging review using a pre-defined data-collection template containing 40-variables. MRI features including lesion distribution, tract involvement, diffusion restriction, susceptibility abnormalities, enhancement patterns, meningeal disease, and spinal involvement were analysed descriptively alongside clinical and microbiological data.
Results:
Supratentorial involvement was present in 81.8% (27/33), infratentorial disease in 60.6% (20/33), and multifocal lesions in 60.6% (20/33). Brainstem involvement occurred in 57.6% (19/33). White matter tract dissemination was identified in 66.7% (22/33), with CST involvement in 63.6% (21/33); the "tunnel sign" was observed in 57.6% (19/33). Spinal involvement was present in 42.4% (14/33), including simultaneous brainstem and intramedullary disease in 33.3% (11/33). Diffusion restriction occurred in 72.7% (24/33), while SWI demonstrated haemorrhage or microbleeds in 36.4% (12/33). Initial misdiagnosis occurred in 24.2% (8/33), and 30.3% (10/33) received corticosteroids before definitive diagnosis. In-hospital mortality was 12.1% (4/33).
Conclusions:
Neuro-melioidosis produced extensive craniospinal disease with a disproportionate frequency of brainstem, tract-based, and spinal involvement relative to other bacterial CNS infections. Recognition of this pattern together with blood, tissue, and/or CSF culture, which remain the diagnostic standard, may facilitate earlier diagnostic consideration and targeted microbiological evaluation in endemic settings.
Insights
Neuro-melioidosis, a severe *Burkholderia pseudomallei* infection, frequently affects the brainstem, spinal cord, and white matter tracts. Recognizing these craniospinal MRI patterns aids early diagnosis in endemic areas.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Neuro-melioidosis is a rare but life-threatening infection caused by *Burkholderia pseudomallei*.
- Imaging features are diverse and often overlooked, with limited existing literature.
- This study focuses on a multicenter Indian cohort to detail the craniospinal MRI spectrum.
Purpose of the Study:
- To characterize the craniospinal magnetic resonance imaging (MRI) spectrum of neuro-melioidosis.
- To identify recurrent imaging patterns associated with diagnostic delays.
- To analyze imaging findings in a multicenter Indian cohort.
Main Methods:
- Retrospective multicenter case series of 33 patients with confirmed neuro-melioidosis.
- Systematic review of neuroimaging using a 40-variable data-collection template.
- Analysis of MRI features including lesion distribution, tract involvement, diffusion restriction, and spinal disease.
Main Results:
- Extensive craniospinal involvement was observed, with supratentorial (81.8%), infratentorial (60.6%), and multifocal lesions (60.6%).
- Brainstem (57.6%), white matter tract dissemination (66.7%, including CST in 63.6%), and spinal involvement (42.4%) were frequent.
- Diffusion restriction (72.7%) and hemorrhage/microbleeds (36.4%) were noted; misdiagnosis occurred in 24.2%.
Conclusions:
- Neuro-melioidosis presents with extensive craniospinal disease, notably affecting the brainstem, tracts, and spine.
- These patterns are disproportionately frequent compared to other bacterial CNS infections.
- Recognizing these imaging findings alongside microbiological cultures can improve early diagnosis in endemic regions.
