Department of Medicine, Cairns Hospital, Cairns, Australia.
Department of Surgery, Cairns Hospital, Cairns, Australia.
Am J Trop Med Hyg. 2023 May 15;108(6):1212-1214. doi: 10.4269/ajtmh.22-0694. Print 2023 Jun 7.
Encephalomyelitis is the most frequent manifestation of neuromelioidosis in Australia. It is hypothesized that Burkholderia pseudomallei 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 B. pseudomallei, 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 B. pseudomallei invaded the vagus nerve in the thorax, was traveling proximally-involving 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 B. pseudomallei to enter the brainstem in cases of melioidosis-related encephalomyelitis.
脑脊髓炎是澳大利亚类鼻疽最常见的表现形式。人们假设，如果合并头皮感染，布氏杆菌假单胞菌会直接进入大脑引起脑脊髓炎；或者在外周或颅神经内传播到大脑。一名 76 岁男子出现发热、声音嘶哑和呃逆。胸部影像学显示广泛双侧肺炎伴纵隔淋巴结病，血液培养分离出布氏杆菌假单胞菌，鼻内镜检查证实左侧声带麻痹。磁共振成像未发现颅内异常，但显示左侧迷走神经增大并增强，符合神经炎。我们假设布氏杆菌假单胞菌在胸部侵入迷走神经，向近端移动，累及左侧喉返神经，导致左侧声带麻痹，但尚未到达脑干。鉴于类鼻疽病例中肺炎的频率很高，迷走神经可能代表布氏杆菌假单胞菌进入脑干的另一种（事实上是常见的）途径，在类鼻疽相关性脑脊髓炎中。
