Transverse myelitis secondary to Melioidosis; A case report

BMC Infectious Diseases

Enoka Corea¹  Muditha Manjula²  Harith Wimalaratna³  Shanika Nandasiri³ 

[1] Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;Department of Medical Microbiology, Teaching Hospital, Kandy, Sri Lanka;Department of Medicine, Teaching Hospital, Kandy, Sri Lanka

关键词: Psoas abscess;    Flaccid paraplegia;    Burkholderia pseudomallei;    Transverse myelitis;    Melioidosis;   

Others  :  1159659
DOI  :  10.1186/1471-2334-12-232

 received in 2012-07-06, accepted in 2012-09-20,  发布年份 2012

【 摘 要 】

Background

Melioidosis has become an emerging infection in Sri Lanka; a country which is considered non endemic for it. Paraplegia due to Burkholderia pseudomallei is a very rare entity encountered even in countries where the disease is endemic. There are no reported cases of transverse myelitis due to melioidosis in Sri Lankan population thus we report the first case.

Case presentation

A 21 year old farmer presented with sudden onset bi lateral lower limb weakness, numbness and urine retention. Examination revealed flaccid areflexic lower limbs with a sensory loss of all modalities and a sensory level at T₁₀ together with sphincter involvement. MRI of the thoracolumbar spine showed extensive myelitis of the thoracic spine complicating left psoas abscess without definite extension to the spinal cord or cord compression. Burkholderia pseudomallei was isolated from the psoas abscess pus cultures and the diagnosis of melioidosis was confirmed with high titers of Burkholderia pseudomallei antibodies and positive PCR. He was treated with high doses of IV ceftazidime and oral cotrimoxazole for one month with a plan to continue cotrimoxazole and doxycycline till one year. Patient’s general condition improved but the residual neurological problems persisted.

Conclusion

The exact pathogenesis of spinal cord melioidosis is not quite certain except in the cases where there is direct microbial invasion, which does not appear to be the case in our patient. We postulate our patient’s presentation could be due to ischemia of the spinal cord following septic embolisation or thrombosis of spinal artery due to the abscess nearby. A neurotrophic exotoxin causing myelitis or post infectious immunological demyelination is yet another possibility. This emphasizes the necessity of further studies to elucidate the exact pathogenesis in this type of presentations.

Health care professionals in Sri Lanka, where this is an emerging infection, need to improve their knowledge regarding this disease and should have high degree of suspicion to make a correct and a timely diagnosis to reduce the morbidity and mortality due to Burkholderia pseudomallei infection. It is highly likely that this infection is under diagnosed in developing countries where diagnostic facilities are minimal. Therefore strategies to improve the awareness and upgrade the diagnostic facilities need to be implemented in near future.

【 授权许可】

   
2012 Nandasiri et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Corea E, Thevanesam V, Perera S, Jayasinghe I, Ekanayake A, Masakorala J, Inglis TJJ: Melioidosis in Sri Lanka an emerging infection. SLJID 2012, 1(2):2-8.
• [2]Currie BJ, Fisher DA, Howard DM, Burrow JNC, Lo D, Selvanayagam S, Anstey NM, Huffam SE, Snelling PL, Marks PJ, Stephens DP, Lum GD, Jacups SP, Krause VL: Endemic melioidosis in tropical Northern Australia: a 10 year prospective study and review of the literature. Clin Infect Dis 2000, 31:981-986.
• [3]How SH, Liam CK: Melioidosis: a potentially life threatening infection. Med J Malaysia 2006, 61(3):386-393.
• [4]Allwood EM, Devenish RJ, Prescott M, Adler B, Boyce JD: Srtategies for intracellular survival of Burkholderia pseudomallei. Front Microbiol 2011, 2:170.
• [5]Currie BJ, Fisher DA, Diane MH, Burrow JNC: Neurological melioidosis. Acta Trop 2000, 74:145-151.
• [6]Haran MJ, Jenney AW, Keenan RJ, Flavell HD, Anstey NM, Currie BJ: Paraplegia secondary to Burkholderia pseudomallei myelitis: a case report. Arch Phys Med rehabil 2001, 82:1630-1632.
• [7]Bartley PP, Pender MP, Woods ML II, Walker D, Douglas JA, Allworth AM, Eisen DP, Currie BJ: Spinal cord disease due to melioidosis. Trans R Soc Trop Med Hyg 1999, 93:175-176.
• [8]Currie BJ, Ward L, Cheng AC: The epidemiology and clinical spectrum of Melioidosis: 540 cases from the 20 year Darwin Prospective Study. PLoS Negl Trop Dis 2010, 4:11.