Neuromelioidosis: Craniospinal MRI Findings in <i>Burkholderia pseudomallei</i> Infection

Hsu, Charlie; Singh, Dalveer; Kwan, Gigi Nga Chi; Deuble, Martin; Aquilina, Chloe; Korah, Ipeson; Norton, Robert

doi:10.1111/jon.12282

Cited by 36 publications

(30 citation statements)

References 25 publications

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“…In patients with CNS involvement, CT images may be normal and magnetic resonance imaging (MRI) is preferred. MRI often shows extensive hyperintense changes on T2-weighted images; microabscesses, leptomeningeal enhancement, and trigeminal nerve involvement are also common [ 54 , 80 , 81 ].…”

Section: Diagnosismentioning

confidence: 99%

Melioidosis: An Australian Perspective

2018

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Burkholderia pseudomallei is endemic in northern Australia, with cases of melioidosis most commonly occurring during the wet season in individuals with diabetes, hazardous alcohol use, and chronic kidney disease. Pneumonia is the most common presentation and the majority of patients are bacteraemic—however, infection may involve almost any organ, with the skin and soft tissues, genitourinary system, visceral organs, and bone and joints affected most commonly. Central nervous system involvement is rarer, but has a high attributable mortality. Increased awareness of the disease amongst healthcare providers, ready access to appropriate antibiotic therapy and high-quality intensive care services has resulted in a sharp decline in the case fatality rate over the last 20 years. Further improvement in clinical outcomes will require a greater understanding of the disease′s pathophysiology, its optimal management, and more effective strategies for its prevention.

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Section: Diagnosismentioning

confidence: 99%

Melioidosis: An Australian Perspective

2018

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“…A recent study by Chia-Tsong Hsu et al. 8 observed rim-enhancing microabscesses in the brain parenchyma and medulla of the spinal cord, particularly along white matter tracts; in addition, meningeal enhancement, extradural and scalp abscesses and skull osteomyelitis were also found. Ring-enhancing lesions and spinal extradural collections were also reported by Deuble et al., 7 while abscess formation and collections were demonstrated by Muthusamy et al.…”

Section: Discussionmentioning

confidence: 93%

“… 5 , 7 , 8 The most recent study was a retrospective analysis of the magnetic resonance imaging findings in 10 patients with neuromelioidosis. 8 The main features were the presence of rim-enhancing microabscesses along white matter tracts (including the corticospinal tracts, corpus callosum and cerebellar peduncles), thickening and enhancement of the trigeminal nerves (with spread to the trigeminal nuclei) and extra-axial disease (meningeal enhancement, extradural abscess, skull osteomyelitis and/or scalp abscess). 8 In the present study, disease characteristics and imaging features were analyzed retrospectively in patients with neuromelioidosis.…”

Section: Introductionmentioning

confidence: 99%

Neuromelioidosis: a series of seven cases in Hainan province, China

Zhan

2017

J Int Med Res

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Melioidosis, which is caused by Burkholderia pseudomallei, is predominately a disease of tropical climates and is especially widespread in south-east Asia and northern Australia. Melioidosis affecting the central nervous system has a low incidence but a high mortality. We present seven cases of neuromelioidosis and analyze the disease characteristics and imaging features. Typical clinical features of this disease included high fever and headache. Five patients had an irregular fever with a temperature ≥ 39℃. Peripheral blood leukocytes and the neutrophil ratio were raised in all patients. On computed tomography and magnetic resonance imaging the disease mainly manifested as intracerebral single or multiple nodules, as well as ring and flake-like enhancements with rapid lesion progression. This study demonstrated the importance of imaging examination in the clinical evaluation and diagnosis of neuromelioidosis.

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“…Thus, these nerves provide direct conduits between the nasal cavity and the CNS. [13]We have previously shown that B. pseudomallei rapidly (within 24 h of intranasal inoculation) reached the olfactory bulb via the olfactory nerve, or the brainstem and spinal cord via the trigeminal nerve in mice [14-18]. One study identified thickening of the trigeminal nerve in three out of seven human neurological melioidosis patients, indicative of nerve invasion to the CNS, bypassing the blood-brain barrier.…”

mentioning

confidence: 99%

“…One study identified thickening of the trigeminal nerve in three out of seven human neurological melioidosis patients, indicative of nerve invasion to the CNS, bypassing the blood-brain barrier. The same three patients were also exhibiting signs of sinusitis [13]. We have also shown that the bacterial protein Burkholderia intracellular motility A (BimA), which mimics a eukaryotic actin polymerase to mobilise a tail of host cell actin leading to bacterial motility, cell-cell dissemination and cell-cell fusion, is important for CNS invasion [18].…”

mentioning

confidence: 99%

Burkholderia pseudomallei invades the olfactory nerve and bulb after epithelial injury in mice and causes the formation of multinucleated giant glial cells in vitro

et al. 2020

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The infectious disease melioidosis is caused by the bacterium Burkholderia pseudomallei. Melioidosis is characterised by high mortality and morbidity and can involve the central nervous system (CNS). We have previously discovered that B. pseudomallei can infect the CNS via the olfactory and trigeminal nerves in mice. We have shown that the nerve path is dependent on mouse strain, with outbred mice showing resistance to olfactory nerve infection. Damage to the nasal epithelium by environmental factors is common, and we hypothesised that injury to the olfactory epithelium may increase the vulnerability of the olfactory nerve to microbial insult. We therefore investigated this, using outbred mice that were intranasally inoculated with B. pseudomallei, with or without methimazole-induced injury to the olfactory neuroepithelium. Methimazole-mediated injury resulted in increased B. pseudomallei invasion of the olfactory epithelium, and only in pre-injured animals were bacteria found in the olfactory nerve and bulb. In vitro assays demonstrated that B. pseudomallei readily infected glial cells isolated from the olfactory and trigeminal nerves (olfactory ensheathing cells and trigeminal Schwann cells, respectively). Bacteria were degraded by some cells but persisted in other cells, which led to the formation of multinucleated giant cells (MNGCs), with olfactory ensheathing cells less likely to form MNGCs than Schwann cells. Double Cap mutant bacteria, lacking the protein BimA, did not form MNGCs. These data suggest that injuries to the olfactory epithelium expose the primary olfactory nervous system to bacterial invasion, which can then result in CNS infection with potential pathogenic consequences for the glial cells.PLOS Neglected Tropical Diseases | https://doi.Infections of the central nervous system (CNS), though uncommon, are associated with severe morbidity and mortality. Burkholderia pseudomallei, the causative agent of melioidosis, can infect the CNS. We have shown that B. pseudomallei can enter the CNS via peripheral nerves extending between the nasal cavity and the brain (bypassing the bloodbrain/blood-cerebrospinal fluid barriers). In the current study, we show that prior injury to the olfactory epithelium can increase B. pseudomallei invasion of the olfactory nerve and bulb, highlighting a novel risk factor for CNS infections. We also demonstrate the ability of peripheral nerve glia to internalise B. pseudomallei, resulting in the formation of multinucleated giant cells (MNGCs), dependent on the bacterial protein BimA. These findings provide important new insights into the pathogenesis of B. pseudomallei.B. pseudomallei infects olfactory bulb after injury PLOS Neglected Tropical Diseases | https://doi.

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Neuromelioidosis: Craniospinal MRI Findings in Burkholderia pseudomallei Infection

Cited by 36 publications

References 25 publications

Melioidosis: An Australian Perspective

Melioidosis: An Australian Perspective

Neuromelioidosis: a series of seven cases in Hainan province, China

Burkholderia pseudomallei invades the olfactory nerve and bulb after epithelial injury in mice and causes the formation of multinucleated giant glial cells in vitro

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