Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review

Authors

  • Mohd ’Ammar Ihsan Ahmad Zamzuri Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
  • Mohd Nazrin Jamhari Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
  • Haniff Mohd Nawi Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia https://orcid.org/0000-0002-2938-5931
  • Mohd Rohaizat Hassan Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia https://orcid.org/0000-0002-4658-6532
  • Nicholas Tze Ping Pang Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia
  • Mohd Amiruddin Mohd Kassim Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia; Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia https://orcid.org/0000-0003-0681-2117
  • Syed Sharizman Syed Abdul Rahim Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia https://orcid.org/0000-0002-9090-2563
  • Mohammad Saffree Jeffree Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia https://orcid.org/0000-0002-0373-4451
  • Shi Yun Lee Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu Sabah, Malaysia https://orcid.org/0000-0002-9637-6736

DOI:

https://doi.org/10.3889/oamjms.2021.6688

Keywords:

Melioidosis, Central nervous system infections, Neurological, Cranial, Complication, Epidemiology

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.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Yip TW, Hewagama S, Mayo M, Price EP, Sarovich DS, Bastian I, et al. Endemic melioidosis in residents of desert region after atypically intense rainfall in central Australia, 2011. Emerg Infect Dis. 2015;21(6):1038-40. https://doi.org/10.3201/eid2106.141908 PMid:25988301 DOI: https://doi.org/10.3201/eid2106.141908

Currie BJ, Jacups SP, Cheng AC, Fisher DA, Anstey NM, Huffam SE, et al. Melioidosis epidemiology and risk factors from a prospective whole-population study in northern Australia. Trop Med Int Health. 2004;9(11):1167-74. https://doi.org/10.1111/j.1365-3156.2004.01328.x PMid:15548312 DOI: https://doi.org/10.1111/j.1365-3156.2004.01328.x

Currie BJ, Fisher DA, Howard DM, Burrow JN, Lo D, Selva-Nayagam S, et al. Endemic melioidosis in Tropical Northern Australia: A 10-year prospective study and review of the literature. Clin Infect Dis 2000;31(4):981-6. https://doi.org/10.1086/318116 PMid:11049780 DOI: https://doi.org/10.1086/318116

Wiersinga WJ, van der Poll T, White NJ, Day NP, Peacock SJ. Melioidosis: Insights into the pathogenicity of Burkholderia pseudomallei. Nat Rev Microbiol. 2006;4:272-82. https://doi.org/10.1038/nrmicro1385 DOI: https://doi.org/10.1038/nrmicro1385

Liang CC, Chen SY, Chen TY, Chen ST. Central nervous system melioidosis mimics malignancy: A case report and literature review. World Neurosurg. 2016;89:732.e19-23. https://doi.org/10.1016/j.wneu.2016.01.093 PMid:26882971 DOI: https://doi.org/10.1016/j.wneu.2016.01.093

White ME, Hunt J, Connell C, Langdon K. Paediatric neurological melioidosis: A rehabilitation case report. Rural Remote Health. 2016;16(1):3702. https://doi.org/10.22605/rrh3702 PMid:26897103 DOI: https://doi.org/10.22605/RRH3702

Ng CS, Azmin S, Law ZK, Sahathevan R, Wan Yahya WN, Remli R, et al. An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism. Med J Aust. 2015;202(6):333-4. https://doi.org/10.5694/mja14.00229 PMid:25832163 DOI: https://doi.org/10.5694/mja14.00229

Wijekoon P, Bandara KA, Kailainathan A, Chandrasiri NS, Hapuarachchi CT. Guillaine-barre syndrome: A rare complication of melioidosis. A case report. BMC Infect Dis. 2016;16:388. https://doi.org/10.1186/s12879-016-1719-4 PMid:27506202 DOI: https://doi.org/10.1186/s12879-016-1719-4

Chen GB, Tuan SH, Chen LH, Lin WS. Neurological melioidosis (Burkholderia pseudomallei) in a chronic psychotic patient treated with antipsychotics: A case report. Medicine (United States). 2018;97(24):e11110. https://doi.org/10.1097/MD.0000000000011110 PMid:29901631 DOI: https://doi.org/10.1097/MD.0000000000011110

Kumar MP, Krishnamurthy S, Venkateswaran VS, Mahadevan S, Lalitha M, Sistla S, et al. Brainstem micro-abscesses caused by Burkholderia pseudomallei in a 10-month-old infant: A case report. Paediatr Int Child Health. 2017;37(3):230-2. https://doi.org/10.1080/20469047.2016.1198560 PMid:27376438 DOI: https://doi.org/10.1080/20469047.2016.1198560

Arif MA, Abid MH, Renganathan R, Siddiqui KA. Central and peripheral nervous system involvement in neuromelioidosis. BMJ Case Rep. 2015;2015:bcr2015211001. https://doi.org/10.1136/bcr-2015-211001 PMid:26494715 DOI: https://doi.org/10.1136/bcr-2015-211001

Loh TL, Latis S, Crossland G, Patel H. Disseminated melioidosis in the head and neck. BMJ Case Rep. 2017;2017:bcr2016218606. https://doi.org/10.1136/bcr-2016-218606 PMid:28096229 DOI: https://doi.org/10.1136/bcr-2016-218606

Chia-Tsong Hsu C, Singh D, Kwan G, Deuble M, Aquilina C, Korah I, et al. Neuromelioidosis: Craniospinal MRI findings in Burkholderia pseudomallei infection. J Neuroimaging. 2016;26:75-82. https://doi.org/10.1111/jon.12282 PMid:26256582 DOI: https://doi.org/10.1111/jon.12282

Huang WY, Wu G, Chen F, Li MM, Li JJ. Multi-systemic melioidosis: A clinical, neurological, and radiological case study from Hainan Province, China. BMC Infect Dis. 2018;18:649. https://doi.org/10.1186/s12879-018-3569-8 DOI: https://doi.org/10.1186/s12879-018-3569-8

Amarasena HL, Silva FH, Tilakaratna PM, Jayamanne SF, Ranawaka UK. Melioidosis with a subdural collection a case report. BMC Infect Dis. 2019;19(1):143. https://doi.org/10.1186/s12879-019-3782-0 PMid:30755178 DOI: https://doi.org/10.1186/s12879-019-3782-0

Zhan Y, Wu Y, Li Q, Yu A. Neuromelioidosis: A series of seven cases in Hainan province, China. J Int Med Res. 2017;45(2):856-67. https://doi.org/10.1177/0300060516685967 PMid:28351287 DOI: https://doi.org/10.1177/0300060516685967

Ganapathy S, Nair VK. Neuroinfectious diseases rare presentations of CNS melioidosis an institutional experience. J Neuroinfect Dis. 2018;9:2-5. https://doi.org/10.4172/2314-7326.1000278 DOI: https://doi.org/10.4172/2314-7326.1000278

Saravu K, Kadavigere R, Shastry AB, Pai R, Mukhopadhyay C. Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India. J Infect Dev Ctries. 2015;9(11):1289-93. https://doi.org/10.3855/jidc.6586 PMid:26623640 DOI: https://doi.org/10.3855/jidc.6586

Fong SL, Shyanwong J, Tan AH, Low SC, Tan CT. Neurological melioidosis in East Malaysia: Case series and review of the literature. Neurol Asia 2017;22(1):25-32.

Nayak R, Patel B, Raju K. Chronic pachymenigitis with dural venous sinus thrombosis: An unusual presentation of cranial melioidosis. Neurol India. 2018;66(4):1185-7. https://doi.org/10.4103/0028-3886.237015 PMid:30038121 DOI: https://doi.org/10.4103/0028-3886.237015

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DA, et al. Melioidosis. Nat Rev Dis Prim. 2018;4:17107. https://doi.org/10.1038/nrdp.2017.107 PMid:29388572 DOI: https://doi.org/10.1038/nrdp.2017.107

Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol. 2016;1(1):15008. https://doi.org/10.1038/nmicrobiol.2015.8 PMid:26877885 DOI: https://doi.org/10.1038/nmicrobiol.2015.8

Currie BJ, Fisher DA, Anstey NM, Jacups SP. Melioidosis: Acute and chronic disease, relapse and re-activation. Trans R Soc Trop Med Hyg. 2000;94(3):301-4. https://doi.org/10.1016/s0035-9203(00)90333-x PMid:10975006 DOI: https://doi.org/10.1016/S0035-9203(00)90333-X

Owen W, Smith S, Kuruvath S, Anderson D, Hanson J. Melioidosis of the central nervous system; a potentially lethal impersonator. IDCases. 2021;23(6):e01015. https://doi.org/10.1016/J.IDCR.2020.E01015 DOI: https://doi.org/10.1016/j.idcr.2020.e01015

Lau SK, Sridhar S, Ho CC, Chow WN, Lee KC, Lam CW, et al. Laboratory diagnosis of melioidosis: Past, present and future. Exp Biol Med. 2015;240(6):742-51. https://doi.org/10.1177/1535370215583801 PMid:25908634 DOI: https://doi.org/10.1177/1535370215583801

Currie BJ. Melioidosis: Evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respir Crit Care Med. 2015;36(1):111-25. https://doi.org/10.1055/s-0034-1398389 PMid:25643275 DOI: https://doi.org/10.1055/s-0034-1398389

Deuble M, Aquilina C, Norton R. Neurologic melioidosis. Am J Trop Med Hyg. 2013;89(3):535-9. https://doi.org/10.4269/ajtmh.12-0559 PMid:23836574 DOI: https://doi.org/10.4269/ajtmh.12-0559

Donahue MA, Newcomb G, Spinella S, Prasad P, Liesveld J, Egan CT, et al. CNS melioidosis in a traveler returning from cabo, Mexico. In: Open forum Infect. Oxford: Oxford University Press US; 2019. p. ofz005. https://doi.org/10.1093/ofid/ofz005 DOI: https://doi.org/10.1093/ofid/ofz005

Fong SL, Wong JS, Tan AH, Low SC, Tan CT. Neurological melioidosis in East Malaysia: Case series and review of the literature. Neurol. Asia. 2017;22:25-32.

St John JA. Trojan horse L-selectin monocytes: A portal of Burkholderia pseudomallei entry into the brain. Virulence. 2017;8(6):611-2. https://doi.org/101080/2150559420161250997 PMid:27763813 DOI: https://doi.org/10.1080/21505594.2016.1250997

St John JA, Walkden H, Nazareth L, Beagley KW, Ulett GC, Batzloff MR, et al. Burkholderia pseudomallei rapidly infects the brain stem and spinal cord via the trigeminal nerve after intranasal inoculation. Infect Immun. 2016;84(9):2681-8. https://doi.org/10.1128/iai.00361-16 PMid:27382023 DOI: https://doi.org/10.1128/IAI.00361-16

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. https://doi.org/10.1371/journal.pntd.0000900 PMid:21152057 DOI: https://doi.org/10.1371/journal.pntd.0000900

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(4):e0007320. https://doi.org/10.1371/journal.pntd.0007320 PMid:31022232 DOI: https://doi.org/10.1371/journal.pntd.0007320

Downloads

Published

2021-09-04

How to Cite

1.
Zamzuri M ’Ammar IA, 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 [Internet]. 2021 Sep. 4 [cited 2024 May 26];9(F):318-26. Available from: https://oamjms.eu/index.php/mjms/article/view/6688

Issue

Section

Narrative Review Article

Categories

Most read articles by the same author(s)