{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:11:29Z","timestamp":1780499489466,"version":"3.54.1"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Melioidosis, which is caused by\n                    <jats:italic>Burkholderia pseudomallei<\/jats:italic>\n                    , involves the nervous system in up to 10% of cases and carries high mortality. Although cranial nerve involvement is described in neuromelioidosis, spinal nerve involvement and possible central nervous system spread through spinal nerves are rarely reported. After an index case with brachial plexus involvement, we screened all patients with neuromelioidosis admitted to our institute between November 2024 and April 2025 for spinal nerve and\/or plexus involvement. Among 11 patients with neuromelioidosis, 4 had peripheral nerve and\/or plexus involvement. Three patients also had concomitant encephalomyelitis. Glycemic status and exposure to immunosuppressive therapy appeared to influence the clinical phenotype. Although Guillain\u2013Barre syndrome-like presentations have been described in neuromelioidosis, our patients had features atypical of Guillain\u2013Barre syndrome. We describe the clinical and neuroimaging features of these four patients. Recognition that concurrent central and spinal peripheral nervous system involvement can occur in neuromelioidosis has diagnostic and therapeutic implications.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0668","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:32:14Z","timestamp":1776173534000},"page":"1058-1061","source":"Crossref","is-referenced-by-count":0,"title":["Brachial and Lumbosacral Plexitis in Neuromelioidosis: Clinical and Magnetic Resonance Neurography Features from an Endemic Region in Southern India"],"prefix":"10.4269","volume":"114","author":[{"given":"Pari Thenmozhi","family":"Hariswar","sequence":"first","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkateswaran","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surendran","family":"Deepanjali","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pillai","family":"Vivekanandan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamilarasu","family":"Kadhiravan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vellathussery Chakkalakkoombil","family":"Sunitha","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haris","family":"Abin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Govindan","family":"Dinakar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"e176","article-title":"A call to action: Time to recognise melioidosis as a neglected tropical disease","volume":"22","author":"Savelkoel","year":"2022"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0007320","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"},{"key":"b3","series-title":"Nat Rev Neurosci","first-page":"345","article-title":"Microbes\u2019 roadmap to neurons","volume":"12","author":"Kristensson","year":"2011"},{"key":"b4","series-title":"Neurol India","first-page":"113","article-title":"Craniospinal MRI findings in neuromelioidosis","volume":"71","author":"Naik","year":"2023"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"1212","article-title":"Case report: Vagal nerve neuritis associated with pulmonary melioidosis provides potential insights into the pathophysiology of neuromelioidosis","volume":"108","author":"Matthews","year":"2023"},{"key":"b6","series-title":"BMC Infect Dis","first-page":"232","article-title":"Transverse myelitis secondary to melioidosis: A case report","volume":"12","author":"Nandasiri","year":"2012"},{"key":"b7","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":"b8","series-title":"Sci Rep","first-page":"13632","article-title":"Burkholderia pseudomallei-loaded cells act as a Trojan horse to invade the brain during endotoxemia","volume":"8","author":"Hsueh","year":"2018"},{"key":"b9","series-title":"J Infect Dis","first-page":"1761","article-title":"Nasal-associated lymphoid tissue and olfactory epithelium as portals of entry for Burkholderia pseudomallei in murine melioidosis","volume":"199","author":"Owen","year":"2009"},{"key":"b10","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":"b11","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":"b12","series-title":"Am J Trop Med Hyg","first-page":"1260","article-title":"Case report: Ascending myelo-encephalitis after a penetrating injury to the foot: An atypical case of neuromelioidosis","volume":"104","author":"Varkey Maramattom","year":"2021"},{"key":"b13","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":"b14","series-title":"Ann Indian Acad Neurol","first-page":"681","article-title":"Guillain Barre syndrome as a manifestation of neurological melioidosis","volume":"16","author":"Krovvidi","year":"2013"},{"key":"b15","series-title":"BMJ Case Rep","first-page":"bcr2015211001","article-title":"Central and peripheral nervous system involvement in neuromelioidosis","volume":"2015","author":"Arif","year":"2015"},{"key":"b16","series-title":"Nat Rev Neurol","first-page":"671","article-title":"Diagnosis and management of Guillain\u2013Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard","year":"2019"},{"key":"b17","series-title":"PLoS One","first-page":"e12485","article-title":"Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class models","volume":"5","author":"Limmathurotsakul","year":"2010"},{"key":"b18","series-title":"Neurology","first-page":"3150","article-title":"Neuromelioidosis in the guise of a demyelinating illness (P1-1.Virtual)","volume":"98","author":"Ratnayake","year":"2022"},{"key":"b19","series-title":"Neurol India","first-page":"767","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"},{"key":"b20","series-title":"J Infect Dis","first-page":"99","article-title":"A critical role for neutrophils in resistance to experimental infection with Burkholderia pseudomallei.","volume":"195","author":"Easton","year":"2007"},{"key":"b1","series-title":"Lancet Infect Dis","first-page":"e176","article-title":"A call to action: Time to recognise melioidosis as a neglected tropical 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Dis","first-page":"232","article-title":"Transverse myelitis secondary to melioidosis: A case report","volume":"12","author":"Nandasiri","year":"2012"},{"key":"b7","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":"b8","series-title":"Sci Rep","first-page":"13632","article-title":"Burkholderia pseudomallei-loaded cells act as a Trojan horse to invade the brain during endotoxemia","volume":"8","author":"Hsueh","year":"2018"},{"key":"b9","series-title":"J Infect Dis","first-page":"1761","article-title":"Nasal-associated lymphoid tissue and olfactory epithelium as portals of entry for Burkholderia pseudomallei in murine melioidosis","volume":"199","author":"Owen","year":"2009"},{"key":"b10","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":"b11","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":"b12","series-title":"Am J Trop Med Hyg","first-page":"1260","article-title":"Case report: Ascending myelo-encephalitis after a penetrating injury to the foot: An atypical case of neuromelioidosis","volume":"104","author":"Varkey Maramattom","year":"2021"},{"key":"b13","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":"b14","series-title":"Ann Indian Acad Neurol","first-page":"681","article-title":"Guillain Barre syndrome as a manifestation of neurological melioidosis","volume":"16","author":"Krovvidi","year":"2013"},{"key":"b15","series-title":"BMJ Case Rep","first-page":"bcr2015211001","article-title":"Central and peripheral nervous system involvement in neuromelioidosis","volume":"2015","author":"Arif","year":"2015"},{"key":"b16","series-title":"Nat Rev Neurol","first-page":"671","article-title":"Diagnosis and management of Guillain\u2013Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard","year":"2019"},{"key":"b17","series-title":"PLoS One","first-page":"e12485","article-title":"Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class 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