encephalomyelitis due to Melioidosis

 Q; 44 years old male who recently returned from a trip visiting northern Australia is now admitted with sepsis. Subsequent workup led to the diagnosis of Melioidosis. What are the characteristic neurological features of encephalomyelitis due to Melioidosis? 

 Answer: Melioidosis is an infective disease by the facultative intracellular gram-negative bacterium, Burkholderia pseudomallei. It is found in soil and fresh surface water and is more prevalent in wet seasons. It is endemic in Southeast Asia including Indian sub-continent, Thailand, Malaysia, Singapore, Australia, and China. Northeastern Thailand and northern Australia are known as "hyperendemic" areas. 

Encephalomyelitis in melioidosis has characteristic features with consciousness normal or near-normal. It primarily involves the brainstem with possible abscess formation. It causes unilateral upper motor neuron limb weakness, cerebellar signs, cranial nerve palsies, and/or flaccid paraparesis alone. Cranial nerves VI, VII are mostly involved as well as bulbar palsy. 

Resistance to many common antibiotics is common for Burkholderia pseudomallei. Usually, meropenpem is considered the antibiotic of choice.

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References:

1. Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005; 18:383.

2. Currie BJ, Dance DA, Cheng AC. The global distribution of Burkholderia pseudomallei and melioidosis: an update. Trans R Soc Trop Med Hyg 2008; 102 Suppl 1:S1.

3. Currie BJ, Fisher DA, Howard DM, et al. The epidemiology of melioidosis in Australia and Papua New Guinea. Acta Trop 2000; 74:121. 

4. Woods ML 2nd, Currie BJ, Howard DM, et al. Neurological melioidosis: seven cases from the Northern Territory of Australia. Clin Infect Dis 1992; 15:163. 

5. Currie BJ, Fisher DA, Howard DM, Burrow JN. Neurological melioidosis. Acta Trop 2000; 74:145.