Exploring patient characteristics and respiratory impacts of pulmonary melioidosis: A 5-year experience from endemic region of Thailand

<bold>Background</bold> Melioidosis, a disease caused by <italic>Burkholderia</italic> pseudomallei, carries a high mortality and is known as a mimicker of other infectious diseases. Pulmonary involvement emerges as the predominant and most fatal manifestation in melioidosis cases. Despite being a global health concern, pulmonary melioidosis remains insufficiently studied and reported. <bold>Objective</bold> This study aimed to explore patient characteristics, identify risk factors, assess respiratory impacts and outcomes in pulmonary melioidosis. <bold>Methods</bold> A retrospective cohort reviewed patients admitted for bacterial pneumonia between January 1, 2019, and December 31, 2023, at Chaophraya Abhaibubejhr hospital, Prachinburi, Thailand. Patient data were collected and analyzed. <bold>Results</bold> Out of 1,486 adults admitted with bacterial pneumonia, 36 patients (2.4%) were diagnosed with microbiologically confirmed melioidosis. All of them were admitted during Thailand’s rainy season. Thirty of 36 (83.3%) developed acute respiratory failure requiring mechanical ventilation. Twenty of 36 (55.6%) met a new global definition of ARDS (75% were moderate to severe). ARDS was associated with chronic alcohol consumption (<italic>p</italic>=0.002) and low BMI (<19.7 kg/m²) status (<italic>p</italic>=0.029). The overall mortality was 55.6% and 11of 20 (55%) died within 48 hours after hospital admission. There was no statistically significant difference in mortality observed between ARDS and non-ARDS. <bold>Conclusion</bold> Pulmonary melioidosis carries a high potential of mechanical ventilation support, ARDS development and fatal outcomes. Chronic alcohol consumption and low BMI status were identified as risk factors associated with melioidosis-related ARDS.