Epidemiology of neuromelioidosis in asia-pacific: A systematic review

Abstract

BACKGROUND: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. AIM: This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years. METHOD: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015 to 2019. We excluded animal cases and studies that do not have clinical data. RESULTS: We identified 283 relevant articles from the initial search, but only 16 articles fulfilled the criteria. Common risk factors identified were diabetes, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is commonly detected 6–14 days after the first presentation and confirmed by detailed investigations. Radio imaging investigation helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 3–4-week intensive course of intravenous Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole orally for eradication therapy. Oral doxycycline was also prescribed upon discharge. Majority of the patients showed improvement following treatments completion. CONCLUSION: Neuromelioidosis is rare, with relatively nonspecific central nervous system clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radio imaging modalities aid early microbiological sampling and appropriate antibiotic therapy.