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Title: Melioidosis of the central nervous system; impact of the bimABm allele on patient presentation and outcome
Authors: Gora, Hannah
Hasan, Tasnim
Smith, Simon 
Wilson, Ian 
Mayo, Mark
Woerle, Celeste
Webb, Jessica R
Currie, Bart J
Hanson, Josh 
Meumann, Ella M
Issue Date: 2022
Source: Gora H, Hasan T, Smith S, Wilson I, Mayo M, Woerle C, Webb JR, Currie BJ, Hanson J, Meumann EM. Melioidosis of the central nervous system; impact of the bimABm allele on patient presentation and outcome. Clin Infect Dis. 2022 Feb 7:ciac111. doi: 10.1093/cid/ciac111. Epub ahead of print. PMID: 35137005.
Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Abstract: The autotransporter protein Burkholderia intracellular motility A (BimA) facilitates the entry of Burkholderia pseudomallei into the central nervous system (CNS) in mouse models of melioidosis. Its role in the pathogenesis of human cases of CNS melioidosis is incompletely defined. Consecutive culture-confirmed cases of melioidosis at two sites in tropical Australia after 1989 were reviewed. Demographic, clinical and radiological data of the patients with CNS melioidosis were recorded. The bimA allele (bimABm or bimABp) of the B. pseudomallei isolated from each patient was determined. Of the 1587 cases diagnosed at the two sites during the study period, 52 (3.3%) had confirmed CNS melioidosis; 20 (38.5%) had a brain abscess, 18 (34.6%) had encephalomyelitis, 4 (7.7%) had isolated meningitis and 10 (19.2%) had extra-meningeal disease. Among the 52 patients, there were 8 (15.4%) deaths; 17/44 (38.6%) survivors had residual disability. The bimA allele was characterized in 47/52; 17/47 (36.2%) had the bimABm allele and 30 (63.8%) had the bimABp allele. Patients with a bimABm variant were more likely to have a predominantly neurological presentation (odds ratio (OR) (95% confidence interval (CI)): 5.60 (1.52-20.61), p=0.01), to have brainstem involvement (OR (95%CI): 7.33 (1.92-27.95), p=0.004) and to have encephalomyelitis (OR (95%CI): 4.69 (1.30-16.95), p=0.02. Patients with a bimABm variant were more likely to die or have residual disability (odds ratio (95%CI): 4.88 (1.28-18.57), p=0.01). The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Simon Smith, Ian Wilson, Josh Hanson
DOI: 10.1093/cid/ciac111
Keywords: Burkholderia pseudomallei;Brain abscess;Encephalitis;Melioidosis;Virulence
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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