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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(01): 057-064
DOI: 10.1055/s-0041-1729125
Original Article

Neuromelioidosis: A Single-Center Experience with Emphasis on Imaging

Pavithra Mannam
1   Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Vanjare H. Arvind
1   Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Maria Koshy
2   Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
George M. Varghese
3   Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Mathew Alexander
4   Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Sunithi M. Elizabeth
1   Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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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.

Keywords

brain abscess - Burkholderia pseudomallei - calvarial osteomyelitis - neuromelioidosis - scalp collection


Publikationsverlauf

Artikel online veröffentlicht:
19. April 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Gopalakrishnan R, Sureshkumar D, Thirunarayan MA, Ramasubramanian V. Melioidosis: an emerging infection in India. J Assoc Physicians India 2013; 61 (09) 612-614
    PubMedGoogle Scholar
  • 2 Chrispal A, Rajan SJ, Sathyendra S. The clinical profile and predictors of mortality in patients with melioidosis in South India. Trop Doct 2010; 40 (01) 36-38
    CrossrefPubMedGoogle Scholar
  • 3 Wiersinga WJ, van der Poll T, White NJ, Day NP, Peacock SJ. Melioidosis: insights into the pathogenicity of Burkholderia pseudomallei. Nat Rev Microbiol 2006; 4 (04) 272-282
    CrossrefPubMedGoogle Scholar
  • 4 Allwood EM, Devenish RJ, Prescott M, Adler B, Boyce JD. Strategies for intracellular survival of Burkholderia pseudomallei. Front Microbiol 2011; 2: 170
    PubMedGoogle Scholar
  • 5 Pilatz S, Breitbach K, Hein N. et al. Identification of Burkholderia pseudomallei genes required for the intracellular life cycle and in vivo virulence. Infect Immun 2006; 74 (06) 3576-3586
    CrossrefPubMedGoogle Scholar
  • 6 McCormick JB, Sexton DJ, McMurray JG, Carey E, Hayes P, Feldman RA. Human-to-human transmission of Pseudomonas pseudomallei. Ann Intern Med 1975; 83 (04) 512-513
    Google Scholar
  • 7 Mukhopadhya A, Balaji V, Jesudason MV, Amte A, Jeyamani R, Kurian G. Isolated liver abscesses in melioidosis. Indian J Med Microbiol 2007; 25 (02) 150-151
    CrossrefPubMedGoogle Scholar
  • 8 Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis 2010; 4 (11) e900
    CrossrefPubMedGoogle Scholar
  • 9 Ip M, Osterberg LG, Chau PY, Raffin TA. Pulmonary melioidosis. Chest 1995; 108 (05) 1420-1424
    CrossrefPubMedGoogle Scholar
  • 10 Khiangte HL, Robinson Vimala L, Veeraraghavan B, Yesudhason BL, Karuppusami R. Can the imaging manifestations of melioidosis prognosticate the clinical outcome? A 6-year retrospective study. Insights Imaging 2019; 10 (01) 17
    CrossrefPubMedGoogle Scholar
  • 11 Currie BJ, Fisher DA, Howard DM, Burrow JN. Neurological melioidosis. Acta Trop 2000; 74 (02/03) 145-151
    CrossrefPubMedGoogle Scholar
  • 12 Hsu CC, Singh D, Kwan G. et al. Neuromelioidosis: craniospinal MRI findings in Burkholderia pseudomallei infection. J Neuroimaging 2016; 26 (01) 75-82
    CrossrefPubMedGoogle Scholar
  • 13 Padiglione A, Ferris N, Fuller A, Spelman D. Brain abscesses caused by Burkholderia pseudomallei. J Infect 1998; 36 (03) 335-337
    CrossrefPubMedGoogle Scholar
  • 14 Wongwandee M, Linasmita P. Central nervous system melioidosis: a systematic review of individual participant data of case reports and case series. PLoS Negl Trop Dis 2019; 13 (04) e0007320
    CrossrefPubMedGoogle Scholar
  • 15 Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis 1997; 25 (04) 763-779, quiz 780–781
    CrossrefPubMedGoogle Scholar
  • 16 Helbig GM, Callahan JD, Cohen-Gadol AA. Variant intraneural vein-trigeminal nerve relationships: an observation during microvascular decompression surgery for trigeminal neuralgia. Neurosurgery 2009; 65 (05) 958-961, discussion 961
    CrossrefPubMedGoogle Scholar
  • 17 Kosuwon W, Taimglang T, Sirichativapee W, Jeeravipoolvarn P. Melioidotic septic arthritis and its risk factors. J Bone Joint Surg Am 2003; 85 (06) 1058-1061
    CrossrefPubMedGoogle Scholar
  • 18 Teparrakkul P, Tsai JJ, Chierakul W. et al. Rheumatological manifestations in patients with melioidosis. Southeast Asian J Trop Med Public Health 2008; 39 (04) 649-655
    PubMedGoogle Scholar
  • 19 Prasad GL, Kini P, Divya S. Central nervous system melioidosis in the pediatric age group: review. Childs Nerv Syst 2017; 33 (06) 1-6
    PubMedGoogle Scholar