Neuromelioidosis: Craniospinal MRI Findings in Burkholderia pseudomallei Infection.

PURPOSE: To investigate magnetic resonance imaging (MRI) findings of central nervous system (CNS) infection with Burkholderia pseudomallei.

METHODS: Retrospective analysis of 10 patients (5 male and 5 female, age range from 13 to 69 years) with CNS melioidosis confirmed on culture of blood, sputum, cerebrospinal fluid, brain biopsy, and postmortem brain tissue. Clinical data were collected and MRI brain and/or spine were independently reviewed.

RESULTS: Seven patients with brain parenchymal or intramedullary spinal cord lesions demonstrated rim-enhancing microabscesses with propensity for white matter tracts including the corticospinal tracts, corpus callosum, and cerebellar peduncles. Three of these 7 patients also showed thickening and enhancement of the trigeminal nerves with contiguous spread to brain stem trigeminal nuclei. Three patients had isolated extraaxial disease with findings including meningeal enhancement, extradural abscess, skull osteomyelitis, and scalp abscess.

CONCLUSION: Spread of microabscesses along white matter tracts and frequent trigeminal nerve involvement are unique imaging characteristics of CNS melioidosis. These findings may provide insight into potential mechanisms for B. pseuodomallei entry into the CNS through direct axonal transport in cranial nerves bypassing the blood brain barrier. Prompt recognition of the neuroimaging features of this potentially fatal infection may allow for early microbiological culture and treatment.