Neurological melioidosis
Section snippets
Neurological melioidosis in animals and humans
Neurological abnormalities in melioidosis have long been recognised in both animals and humans, although the rate of such abnormalities has usually been low. Early mouse models of infection with Burkholderia pseudomallei demonstrated hind-limb weakness (Dannenberg and Scott, 1958). It was subsequently noted in case reports from animals that there was a predilection for neurological melioidosis in animals to affect the brainstem and spinal cord (Omar, 1963), which was particularly notable in two
Neurologic melioidosis in the Royal Darwin Hospital Prospective Study
Royal Darwin Hospital (RDH) is the referral hospital for the Top End, with a population of around 140 000 (Australian Bureau of Statistics, Canberra 1997). All cases of melioidosis in the Top End are managed under the direction of the Division of Medicine at RDH, with most being admitted to RDH but some being managed in the regional hospitals in Katherine, 300 km to the south of Darwin or Gove to the east. Over the 9-year period from 1989 to 1998, there were 232 cases treated for melioidosis,
Discussion
It is now evident that at least some of the cases presenting with classical neurological melioidosis with involvement of brainstem, cerebellum and spinal cord have direct invasion of the CNS. There are many similarities with the animal case reports and animal studies, where extensive cultures and histology often find evidence of the organism in the CNS and where in a single animal there can be a mixed picture of microabscesses and lymphocytic infiltration.
The predominant mononuclear pleocytosis
Acknowledgements
We would like to acknowledge the expert assistance of Gary Lum, Brian Dwyer and the Microbiology staff of RDH and our medical and nursing colleagues throughout the Top End. In addition, the skills and enthusiasm of our Infectious Diseases registrars is much appreciated as is the support from laboratory staff at the Menzies School of Health Research. Peter Blumbergs provided expert neuropathological opinion on the autopsy tissue.
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