{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T21:01:45Z","timestamp":1765486905309},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Encephalomyelitis is the most frequent manifestation of neuromelioidosis in Australia. It is hypothesized that <jats:italic>Burkholderia pseudomallei<\/jats:italic> causes encephalomyelitis after entering the brain directly, if complicating a scalp infection, or after traveling to the brain within peripheral or cranial nerves. A 76-year-old man presented with fever, dysphonia, and hiccups. Chest imaging demonstrated extensive bilateral pneumonia with mediastinal lymphadenopathy, blood cultures isolated <jats:italic>B. pseudomallei<\/jats:italic>, and nasendoscopy confirmed a left vocal cord palsy. Magnetic resonance imaging identified no intracranial abnormality but demonstrated an enlarged, enhancing left vagus nerve, consistent with neuritis. We hypothesize that <jats:italic>B. pseudomallei<\/jats:italic> invaded the vagus nerve in the thorax, was traveling proximally\u2014involving the left recurrent laryngeal nerve and causing the left vocal cord palsy, but had not yet reached the brainstem. Given the frequency of pneumonia in cases of melioidosis, the vagus nerve may represent an alternative, and indeed common, route for <jats:italic>B. pseudomallei<\/jats:italic> to enter the brainstem in cases of melioidosis-related encephalomyelitis.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0694","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T13:50:39Z","timestamp":1684158639000},"page":"1212-1214","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Vagal Nerve Neuritis Associated with Pulmonary Melioidosis Provides Potential Insights into the Pathophysiology of Neuromelioidosis"],"prefix":"10.4269","volume":"108","author":[{"given":"Rosie J.","family":"Matthews","sequence":"first","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Tjahjono","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cairns Hospital, Cairns, Australia;"},{"name":"Sydney Medical School, University of Sydney, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soon","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cairns Hospital, Cairns, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josh","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Australia;"},{"name":"The Kirby Institute, University of New South Wales, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Clin Microbiol Rev","first-page":"e00006","article-title":"Human melioidosis","volume":"33","author":"Gassiep","year":"2020"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"1737","article-title":"The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0005411","article-title":"The epidemiology and clinical features of melioidosis in Far North Queensland: implications for patient management","volume":"11","author":"Stewart","year":"2017"},{"key":"b4","series-title":"Clin Infect Dis","article-title":"Melioidosis of the central nervous system; impact of the bimABm allele on patient presentation and outcome","author":"Gora","year":"2022"},{"key":"b5","series-title":"Trop Med Infect Dis","first-page":"27","article-title":"Melioidosis: an Australian perspective","volume":"3","author":"Smith","year":"2018"},{"key":"b6","series-title":"Acta Trop","first-page":"145","article-title":"Neurological melioidosis","volume":"74","author":"Currie","year":"2000"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"21","article-title":"Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature","volume":"60","author":"McLeod","year":"2015"},{"key":"b8","series-title":"PLoS Negl Trop Dis","first-page":"e2363","article-title":"Induction of mouse melioidosis with meningitis by CD11b+ phagocytic cells harboring intracellular B. pseudomallei as a Trojan horse","volume":"7","author":"Liu","year":"2013"},{"key":"b9","series-title":"MBio","first-page":"e00025","article-title":"Burkholderia pseudomallei penetrates the brain via destruction of the olfactory and trigeminal nerves: implications for the pathogenesis of neurological melioidosis","volume":"5","author":"St John","year":"2014"},{"key":"b10","series-title":"Infect Immun","first-page":"2681","article-title":"Burkholderia pseudomallei rapidly infects the brain stem and spinal cord via the trigeminal nerve after intranasal inoculation","volume":"84","author":"St John","year":"2016"},{"key":"b11","series-title":"Med J Malaysia","first-page":"471","article-title":"Melioidosis of the head and neck","volume":"56","author":"Lim","year":"2001"},{"key":"b12","series-title":"Infect Dis Rep","first-page":"36","article-title":"Melioidosis of the head and neck: a case series from Eastern India","volume":"12","author":"Mohanty","year":"2020"},{"key":"b13","series-title":"Respirol Case Rep","first-page":"e01017","article-title":"Mediastinal melioidosis: a case series from far North Queensland","volume":"10","author":"Gadsby","year":"2022"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0010604","article-title":"Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia","volume":"16","author":"Davies","year":"2022"},{"key":"b15","series-title":"Auton Neurosci","first-page":"1","article-title":"Functional and chemical anatomy of the afferent vagal system","volume":"85","author":"Berthoud","year":"2000"},{"key":"b16","series-title":"Handb Exp Pharmacol","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/978-3-540-79090-7_5","article-title":"Sensory nerves and airway irritability","volume":"194","author":"Canning","year":"2009"},{"key":"b17","series-title":"J Anat","first-page":"431","article-title":"Topography and extent of pulmonary vagus nerve supply with respect to transthoracic oesophagectomy","volume":"227","author":"Weijs","year":"2015"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"328","article-title":"High rates of premature and potentially preventable death among patients surviving melioidosis in tropical Australia","volume":"101","author":"Hanson","year":"2019"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/6\/article-p1212.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/6\/article-p1212.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/6\/article-p1212.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T13:15:24Z","timestamp":1686143724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/6\/article-p1212.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,7]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.22-0694","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,7]]}}}