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

Hannah Gora, Tasnim Hasan, Simon Smith, Ian Wilson, Mark Mayo, Celeste Woerle, Jessica R Webb, Bart J Currie, Josh Hanson, Ella M Meumann

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background. 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.

Original languageEnglish
Pages (from-to)968-975
Number of pages8
JournalClinical Infectious Diseases
Volume78
Issue number4
Early online date2022
DOIs
Publication statusPublished - 15 Apr 2024

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