Focal Encephalitis Due to Pseudomonas pseudomallei

Tremonti, Lawrence P.; Dart, Leroy H.

doi:10.1001/jama.1971.03180140076015

Cited by 12 publications

(4 citation statements)

References 4 publications

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“…Cultures of cerebrospinal fluid were positive in only one of seven cases, with monocytic pleocytosis the most common finding (488). This should be distinguished from more focal suppurative infections involving the central nervous system, which have been well described (55,62,66,332,438,459). Some of these may represent direct spread from contiguous sites, such as facial sinuses (66) or orbital cellulitis (365).…”

Section: Clinical Syndromesmentioning

confidence: 75%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease

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Section: Clinical Syndromesmentioning

confidence: 75%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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“…This study also describes neurological melioidosis in two children aged 9 and 11 years. Neurological melioidosis is well recognized in Australian adults 6,9,29–;31 . Pathogenesis is uncertain but is felt to be due to direct central nervous system invasion and microabsesses in the spinal cord and brain 9,29,32 .…”

Section: Discussionmentioning

confidence: 99%

“…CSF microscopy and biochemistry usually demonstrates mononuclear pleocytosis with elevated protein 9,27,28 . Outcome is variable from complete recovery to persistent cerebellar ataxia, paraplegia or death 6,9,25–;32 …”

Section: Discussionmentioning

confidence: 99%

Paediatric melioidosis in the Northern Territory of Australia: An expanding clinical spectrum

Edmond

Bauert

Currie

2001

J Paediatrics Child Health

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Melioidosis remains an unusual disease in children in the tropical Northern Territory. The average annual incidence since 1997 is 5.48 per 100 000. This series demonstrates that children in Australia can have serious neurological complications from B. pseudomallei infection. All children living in or visiting tropical Australia are at risk, especially those residing in rural areas in the rainy season. Melioidosis remains a difficult disease to manage, and expert opinion should be sought if B. pseudomallei is cultured from any site.

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“…Total course of the illness is 2-3 weeks. Extrapulmonary forms of melioidosis, either acute or chronic, were acute suppurative parotitis in children (29), osteomyelitis (14), brain abscess (72), hemorrhagic necrosis of occipitoparietal cortex of brain (20), focal encephalitis (135), sternal abscess (129), and genitourinary infections (63, 65, 94). Recrudescent melioidosis was reported 3 years (146), 9 years (19,21), 14 years (119) and 26 years (87) after initial geographic exposure.…”

Section: Clinical Manifestationsmentioning

confidence: 99%