Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review

Mohd ’Ammar Ihsan Ahmad Zamzuri; Mohd Nazrin Jamhari; Haniff Mohd Nawi; Mohd Rohaizat Hassan; Nicholas Tze Ping Pang; Mohd Amiruddin Mohd Kassim; Syed Sharizman Syed Abdul Rahim; Mohammad Saffree Jeffree; Shi Yun Lee

doi:10.3889/oamjms.2021.6688

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.

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