Footprints of human melioidosis in the north western Indian states, expanding endemicity in India

Two Decades of Melioidosis in India: A Comprehensive Epidemiological Review

Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection, particularly affecting individuals with chronic conditions such as diabetes or kidney or liver diseases. This review examines melioidosis in India over the past two decades, focusing on its prevalence, risk factors and clinical manifestations. A PubMed search (2000-2024) identified a rise in melioidosis publications, with most from Southern India, followed by Eastern India, and an increase post-2019. Eight studies from 2010-2022 identified fever (86%), cough (26%) and joint pain (23%) as the most common symptoms, while diabetes (75%), alcohol abuse (19%) and cancer (6%) were primary predisposing factors. Severe clinical manifestations were also observed, including bacteremia (50%), pneumonia (37%) and splenic abscess (18%). Although environmental exposure risks were not significantly high, individuals with diabetes or chronic kidney disease, particularly those working in high-risk environments, were more likely to contract melioidosis. Cryptic environmental factors that might bridge known epidemiological risk factors are also addressed. The review emphasizes the increasing awareness and research in clinical epidemiology and also highlights a gap in studies on antimicrobial treatments, vaccines and environmental surveillance. Targeted interventions in diabetes and poverty hotspots could help control the disease more effectively.

Unearthing the burden of melioidosis in North India - an emerging threat in a non-endemic region

Burkholderia pseudomallei (B. pseudomallei) is the causative agent of the high-mortality disease called melioidosis. It is a severe infection that can be misdiagnosed due to variable presentation and low awareness among clinicians of the disease. It is endemic in India and well-described in southern and eastern coastal states. In the last decade, sporadic cases of melioidosis have been diagnosed in North Indian states, predominantly Rajasthan and Gujarat. The reported cases highlight the many risk factors for infection in this region that was not previously recognised as being endemic for melioidosis, including high prevalence of diabetes mellitus, alcoholism, and large rural population engaged in paddy cultivation. Climate change results in frequent flooding and waterlogging in urban areas, leading to exposure of soil harbouring B. pseudomallei, thus a contributing factor to the rise in cases in cities. As North India has not previously been considered an endemic region for melioidosis, wider awareness amongst clinicians and laboratorians is essential for early identification of symptoms, testing for B. pseudomallei in microbiology laboratories, and timely management of the disease to save lives lost to misdiagnosis. The present article describes various aspects of melioidosis in North India including diverse clinical manifestations, risk factors, and possible reasons for misdiagnosis and underreporting.

The mystery behind a 1000 day fever in a young male

This case is of a 23 year old diabetic male who presented with fever and splenic lesions. He continued to have fever off and on over the next 3 years despite empirical antibiotics and anti-tubercular therapy. No definitive diagnosis could be made despite exhaustive investigations. Finally, a splenectomy resulted in sustained defervescence. The splenic histopathology showed caseating granulomas but aerobic cultures, Xpert MTB/Rif ULTRA, TB and fungal cultures were negative. A final diagnosis of splenic melioidosis was made based on the clinical features, radiology, histopathology, literature review and absence of an alternative diagnosis.