Melioidosis of the Central Nervous System: Impact of the bimABm Allele on Patient Presentation and Outcome

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dc.contributor.authorGora, H.
dc.contributor.authorHasan, T.
dc.contributor.authorSmith, S.
dc.contributor.authorWilson, I.
dc.contributor.authorMayo, M.
dc.contributor.authorWoerle, C.
dc.contributor.authorWebb, J.R.
dc.contributor.authorCurrie, B.J.
dc.contributor.authorHanson, J.
dc.contributor.authorMeumann, E.M.
dc.date.issued2024
dc.description.abstractBackground 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. Methods Consecutive culture-confirmed cases of melioidosis at 2 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. Results Of the 1587 cases diagnosed at the 2 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]: 5.60; 95% confidence interval: 1.52–20.61; P = .01), to have brainstem involvement (OR: 7.33; 1.92–27.95; P = .004), and to have encephalomyelitis (OR: 4.69; 1.30–16.95; P = .02). Patients with a bimABm variant were more likely to die or have residual disability (OR: 4.88; 1.28–18.57; P = .01). Conclusions The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis.
dc.description.statementofresponsibilityHannah Gora, Tasnim Hasan, Simon Smith, Ian Wilson, Mark Mayo, Celeste Woerle, Jessica R. Webb, Bart J. Currie, Josh Hanson, Ella M. Meumann
dc.identifier.citationClinical Infectious Diseases, 2024; 78(4):968-975
dc.identifier.doi10.1093/cid/ciac111
dc.identifier.issn1058-4838
dc.identifier.issn1537-6591
dc.identifier.urihttps://hdl.handle.net/2440/148103
dc.language.isoen
dc.publisherOxford University Press
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1046812
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1098337
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1131932
dc.rights© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
dc.source.urihttps://doi.org/10.1093/cid/ciac111
dc.subjectmelioidosis; Burkholderia pseudomallei; encephalitis; brain abscess; virulence
dc.titleMelioidosis of the Central Nervous System: Impact of the bimABm Allele on Patient Presentation and Outcome
dc.typeJournal article
pubs.publication-statusPublished

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