Gora, Hannah, Hasan, Tasnim, Smith, Simon, Wilson, Ian, Mayo, Mark, Woerle, Celeste, Webb, Jessica R., Currie, Bart J., Hanson, Joshua, and Meumann, Ella M. (2024) Melioidosis of the Central Nervous System: Impact of the bimA Bm Allele on Patient Presentation and Outcome. Clinical Infectious Diseases, 78 (4). pp. 968-975.

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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.

Item ID:	86056
Item Type:	Article (Research - C1)
ISSN:	1537-6591
Copyright Information:	© 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.
Funders:	National Health and Medical Research Council (NHMRC)
Projects and Grants:	NHMRC grant number 1046812, NHMRC grant number 1098337, NHMRC grant number 1131932
Date Deposited:	08 Jul 2025 01:38
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 100%
SEO Codes:	28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280103 Expanding knowledge in the biomedical and clinical sciences @ 100%
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