Neuromelioidosis

Neuromelioidosis is a central nervous system infection caused by the gram-negative bacterium, Burkholderia pseudomallei. The route of transmission commonly occurs through skin abrasion or by inhalation of contaminated water or soil. Risk factors include diabetes mellitus, alcohol intake, chronic renal disease, lung disease, and immunosuppression 1

Melioidosis can involve multiple body systems but central nervous system infection has a mortality rate of approximately 25% and survivors have significant morbidity 1.

Neuromelioidosis has varying clinical presentation including headaches, altered level of consciousness, seizures, cerebellar signs, cranial nerve palsies, limb weakness and hemiparesis. 

The disease is endemic to areas of northern Australia and regions of southeast Asia during the wet seasons.

Burkholderia pseudomallei has been demonstrated on recent microbiology studies to demonstrate axonal spread of disease by penetrating the nasopharyngeal mucosa with spread along the trigeminal and olfactory nerves in infected mice 2. This is an important finding as the bacteria can gain direct access to the CNS bypassing the blood brain barrier

Culture medium

Culture on blood agar / Ashdown's medium or Columbia Horse blood agar (Biomerieux, Australia), incubated in air at 37°.

MRI 

Neuromelioidosis manifests as enhancing microabscesses oriented along white matter tracts such as the corticospinal tract or corpus callosum 3.

Cranial nerve involvement is frequently seen with trigeminal and vestibulocochlear nerves. Contiguous spread of infection along the cranial nerves invariable result in brainstem abscess and rhombencephalitis 3.

Extra-axial disease can manifest as 3

  • extradural brain/spinal abscess
  • skull osteomyelitis
  • scalp abscesses

Melioidosis can involve multiple body systems but central nervous system infection has a mortality rate of approximately 25% and survivors have significant morbidity 1.

Intravenous ceftazidime or imipenem for the eradication phase followed by oral maintenance therapy with either trimethoprim/sulfamethoxazole or doxycycline for at least six to eight months

or

Ceftazidime or meropenem alone or with the addition of co-trimoxazole as the most active regime.

The term neuromelioidosis was coined by the Australian physician Charlie Chia-Tsong Hsu et al. in 2013 3.

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Article Information

rID: 37077
Section: Pathology
Synonyms or Alternate Spellings:
  • Neuromelioidosis
  • CNS manifestations of melioidosis

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