Publication:
Central nervous system melioidosis: A systematic review of individual participant data of case reports and case series

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Issued Date

2019

Resource Type

Article

File Type

application/pdf

ISSN

19352727

DOI

10.1371/journal.pntd.0007320

Other identifier(s)

2-s2.0-85065805798

Rights Holder(s)

Scopus

Bibliographic Citation

PLoS Neglected Tropical Diseases. Vol 13, No.4 (2019)

Suggested Citation

Wongwandee M., Linasmita P. Central nervous system melioidosis: A systematic review of individual participant data of case reports and case series. PLoS Neglected Tropical Diseases. Vol 13, No.4 (2019). doi:10.1371/journal.pntd.0007320 Retrieved from: https://hdl.handle.net/20.500.14740/5394

Title

Central nervous system melioidosis: A systematic review of individual participant data of case reports and case series

Author(s)

Wongwandee M.
 Linasmita P.

Abstract

Background Central nervous system (CNS) melioidosis is rare. However, delayed diagnosis and treatment could lead to fatality. To identify knowledge of CNS melioidosis, we systematically review case reports and case series. Methodology/Principal findings We searched through PubMed, Web of Science and Thai-Journal Citation Index databases as well as Google Scholar with the last date on July 10, 2018. The diagnosis of CNS melioidosis had to be confirmed with culture, serology or polymerase chain reaction. We excluded the animal cases and the studies that the clinical data were not available. We identified 1170 relevant studies, while 70 studies with a total of 120 patients were analyzed. Ninety-three percent of patients were reported from the endemic area of melioidosis. Median age was 40 years (IQR 18-53), and 70% were men. A total of 60% had one or more risk factors for melioidosis. The median duration from clinical onset to diagnosis was ten days (IQR 5-25). Fever (82%), headache (54%), unilateral weakness (57%) and cranial nerve deficits (52%) are among the prominent presentation. Most patient (67%) had at least one extraneurological organ involvement. The CSF profile mostly showed mononuclear pleocytosis (64%), high protein (93%) and normal glucose (66%). The rim-enhancing pattern (78%) is the most frequent neuroimaging finding in encephalomyelitis and brain abscess patients. Both brainstem (34%) and frontal lobe (34%) are the most affected locations. Mortality rate was 20%. Conclusions/Significance This study is the most extensive systematic review of case reports and case series of CNS melioidosis in all age groups. However, the results should be cautiously interpreted due to the missing data issue. The propensity of brainstem involvement which correlates with prominent cranial nerve deficits is the characteristic of CNS melioidosis especially encephalomyelitis type. The presenting features of fever and neurological deficits (especially cranial nerve palsies) along with the mononuclear CSF pleocytosis in a patient who lives in the endemic area and also has the risk factor for melioidosis should raise the CNS melioidosis as the differential diagnosis. © 2019 Wongwandee, Linasmita.

Subject(s)

Amoxicillin plus clavulanic acid
 Ceftazidime
 Chloramphenicol
 Cotrimoxazole
 Doxycycline
 Glucose
 Imipenem
 Meropenem
 Protein
 Alcohol consumption
 Antibiotic therapy
 Antibody titer
 Article
 Blood culture
 Brain abscess
 Brain damage
 Brain stem
 Central nervous system infection
 Cerebrospinal fluid analysis
 Computer assisted tomography
 Consciousness disorder
 Diabetes mellitus
 Disease course
 Disease duration
 Encephalomyelitis
 Facial nerve paralysis
 Fever
 Frontal lobe
 Headache
 Human
 Lung infection
 Melioidosis
 Mortality
 Mortality rate
 Muscle rigidity
 Muscle weakness
 Nuclear magnetic resonance imaging
 Parietal lobe
 Pleocytosis
 Polymerase chain reaction
 Quadriplegia
 Seizure
 Skin infection
 Systematic review
 Travel
 Treatment duration
 Brain
 Burkholderia pseudomallei
 Central nervous system infection
 Differential diagnosis
 Melioidosis
 Microbiology
 Pathogenicity
 Pathology
 Brain
 Burkholderia pseudomallei
 Central Nervous System Bacterial Infections
 Diagnosis, Differential
 Humans
 Melioidosis

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URI

https://hdl.handle.net/20.500.14740/5394

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Scopus: Year 1983-2021

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