{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:42:31Z","timestamp":1791448951715,"version":"4.3.3"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The tunnel sign (linear contrast enhancement along the corticospinal tract) can aid in the early diagnosis of neuromelioidosis, a potentially fatal condition requiring urgent diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methodology<\/jats:title>\n                  <jats:p>We retrospectively analyzed the hospital data of all patients with culture-confirmed melioidosis between 2018 and 2023 in a tertiary care hospital in South India. MRI scans of patients with neuromelioidosis were reviewed for the presence of the tunnel sign.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 177 patients with melioidosis, 21 had possible neurological involvement. Seven had confirmed neuromelioidosis. Of the six patients with neuromelioidosis, where an MRI scan was available, a tunnel sign was noted in four.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We report this study to create awareness amongst physicians to look for this sign in patients with suspected neuromelioidosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trae097","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T08:50:30Z","timestamp":1731919830000},"page":"623-625","source":"Crossref","is-referenced-by-count":2,"title":["Tunnel sign in patients with melioidosis: a case series from South India"],"prefix":"10.1093","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9687-2836","authenticated-orcid":false,"given":"Nitin","family":"Gupta","sequence":"first","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal 576104 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-5659","authenticated-orcid":false,"given":"Sundeep","family":"Malla","sequence":"additional","affiliation":[{"name":"Amrita Institute of Medical Sciences Department of Radiodiagnosis, , Faridabad 121002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirlangi Praveen","family":"Kumar","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal 576104 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Singh","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto Division of Neurology, Department of Pediatrics, , Toronto, ON M5G 1X8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muralidhar","family":"Varma","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal 576104 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0402-1143","authenticated-orcid":false,"given":"Chiranjay","family":"Mukhopadhyay","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Microbiology, , Manipal 576104 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"2025060508164652100_bib1","doi-asserted-by":"crossref","first-page":"100118","DOI":"10.1016\/j.lansea.2022.100118","article-title":"Characteristics and one year outcomes of melioidosis patients in northeastern Thailand: a prospective, multicenter cohort study","volume":"9","author":"Chantratita","year":"2023","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"2025060508164652100_bib2","doi-asserted-by":"crossref","first-page":"bcr2015211001","DOI":"10.1136\/bcr-2015-211001","article-title":"Central and peripheral nervous system involvement in neuromelioidosis","volume":"2015","author":"Arif","year":"2015","journal-title":"BMJ Case Rep"},{"issue":"1","key":"2025060508164652100_bib3","first-page":"57","article-title":"Neuromelioidosis: a single-center experience with emphasis on imaging","volume":"31","author":"Mannam","year":"2021","journal-title":"Indian J Radiol Imaging"},{"issue":"2","key":"2025060508164652100_bib4","doi-asserted-by":"crossref","first-page":"767","DOI":"10.4103\/0028-3886.344622","article-title":"Corticospinal tract involvement in MRI of neuromelioidosis: report of three cases with a review of clinicoradiological features","volume":"70","author":"Raj","year":"2022","journal-title":"Neurol India"},{"issue":"4","key":"2025060508164652100_bib5","doi-asserted-by":"crossref","first-page":"e0007320","DOI":"10.1371\/journal.pntd.0007320","article-title":"Central nervous system melioidosis: a systematic review of individual participant data of case reports and case series","volume":"13","author":"Wongwandee","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"2025060508164652100_bib6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3941\/jrcr.v12i8.3441","article-title":"The tunnel sign revisited: a novel observation of cerebral melioidosis mimicking sparganosis","volume":"12","author":"Peh","year":"2018","journal-title":"J Radiol Case Rep"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/6\/623\/60734716\/trae097.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/6\/623\/60734716\/trae097.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T12:16:57Z","timestamp":1749125817000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/119\/6\/623\/7903059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,18]]},"references-count":6,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,11,18]]},"published-print":{"date-parts":[[2025,6,5]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trae097","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2024,11,18]]}}}