General

Fatal bacteria that gets into the CNS via inhalation?

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11 Jul 2016 - General
 

A recent study has found that a pathogenic bacteria called Burkholderia pseudomallei can enter the brain and spinal cord upon inhalation through the nose via the trigeminal nerve. This bacteria causes a disease called melioidosis, and what struck me was that southeast Asia is among the regions where this bacteria is prevalent. The article also states that about half the population in Southeast Asia may be positive for the bacteria, especially in countries like Cambodia (with a mortality rate as high as 50 %). What’s more, the bacteria can cross the trigeminal nerve and get into the brain within just 24 hours! I shared this info because it struck me as somewhat scary that a bacteria can get into the brain via this route and be fatal so quickly. What is your initial reaction regarding this information? Have any of you encountered such cases in your practice?

Here are the links to the article if you want to give them a read:
News article https://www.sciencedaily.com/releases/2016/07/160708081721.htm
Journal abstract http://iai.asm.org/content/early/2016/06/28/IAI.00361-16

As for cases in other SE Asian countries, I’m not quite sure of the prevalence but hopefully cases will be diagnosed and treated accordingly. With reference to Theekshana’s reply, I’m glad that the patients who contracted the disease were eventually cured. Maybe the disease isn’t so scary after all, except for the chance that the bacteria does travel into the CNS very rapidly. Hopefully they do find a rapid diagnostic kit for this for ease of treatment. Also, I agree with Ziwei’s comments where ...
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@Jennifer and Marinelle - Thanks for your insights on this! I’ve looked up melioidosis in the Philippines and its prevalence is unknown. Also, yes, it was my first time to read about the disease, so I’m thinking that it isn’t that common here in the Philippines. I’ve only come across literature that reported a handful of cases here (namely from San Lazaro Hospital and St. Luke’s Medical Center; but these case studies were written way back in 2002). It’s a bit of consolation that it isn’t very mu...
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Hi! Personally, I’ve never seen a documented case of neurologic melioidosis. Perhaps this is because its classic Cranial MRI characteristics are so similar to that of bacterial meningitis (leptomeningeal enhancement, ring-enhancing lesions, edema, abscesses, predilection for brainstem involvement). Empiric antibiotics may have already been started before obtaining a specimen for culture. This organism is also difficult to isolate and has a low yield for CSF specimens, posing a diagnostic challen...
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My reaction is , do not play with soil and contaminated water unprotected especially if I have open wound. From my hospital rotation, i believe meliodosis is not uncommon. A lot of cases of liver abscess are cases of meliodosis and the main risky group are people doing alot of digging especially construction worker. What is more important is how did the bacterial enter the trigerminal nerve? I guess must be though contact with facial skin. Hence maybe people who are at risk ie doing digging wor...
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I have not encountered any cases of Meliodosis and honestly haven't heard about that disease until reading this article. I am only familiar with the genus Burkholderia from Microbiology classes. Seeing as it is prevalent in Southeast Asia I would think we have testing kits available in our infectious disease specialized centers in our National Capital Region (NCR). What is my initial reaction to this? What firstly popped into my head was "there are individuals who are carriers of Neisse...
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Yeah all the patients eventually were cured of the disease, except one who left our hospital to get admitted to a private hospital because he was rather unsatisfied with our care. The patient was running fever spikes for 2 weeks and it took us that long to diagnose melioidosis (We would have done sooner but as I said the melioidosis antibody testing is available only in certain centers of the country) The patient was not followed up with us, but his condition was not bad so I hope the guy got be...
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Thanks for your comment Dr. Theekshana! I didn't know that melioidosis was difficult to diagnose. I think this fact makes it even scarier. It's sad that this condition’s mortality rate can go even as high as 50 %! Hopefully the cases you encountered got well eventually? Also, yes, transmission via inhalation makes the infection more contagious, so I guess preventive measures should also be done especially in areas where cases of the disease have been encountered. Also, people who have fr...
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Well, I have seen several cases of melioidosis in adults during the time I worked in an infectious diseases hospital. Symptoms and signs of melioidosis are nonspecific so it's extremely hard to diagnose. Diagnosis is almost always on suspicion. All of the patients I have seen presented with pyrexia of unknown origin. Melioidosis antibody testing is not freely available, so the confirmation of melioidosis is done only after exclusion of other more common causes for PUO. A recent history of tr...
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