Clinical and Microbiological Profile, and Outcomes of Melioidosis: A Multicentric Study from South India

INTRODUCTION: Melioidosis is a potentially life-threatening infection caused by the soil-dwelling bacteria Burkholderia pseudomallei. The infection can range from mild localized lesions to severe sepsis, with even fatal outcomes. Transmission occurs through inhalation, ingestion, and skin penetration. High-risk factors include Type 2 diabetes, chronic kidney disease, chronic alcoholism, and immunosuppressive treatments. The clinical presentation, severity, and outcome are influenced by several factors including the route of infection, bacterial load, strain virulence, and specific virulence genes of B. pseudomallei. OBJECTIVES: To identify the risk factors and the epidemiology, and outcomes of the patients with melioidosis. METHOD: A ambipective observational study enrolled patients with history of diabetes and CKD, chronic alcoholics and those on immunosuppressive therapy with varying clinical presentations during the 5-year period. The clinical laboratory, microbiological profile, antibiotic susceptibilities and treatment outcomes were noted. RESULT: Of the 924 enrolled study participants, 43/924 (4.65%) were diagnosed of Melioidosis. The median age was 57 years (IQR - 11 months to 86 years), with males comprising 38/43 (88%) of the cases. 32/43 (74.4%) were diabetic and 4/43(9.3%) had CKD, 7/43(16.2%) were having no risk factors. All cases were culture-positive, with 29/43 (67.4%) from blood, 14/43 (33.33%) from tissue, 8/43(18.6%) having positive in both blood and tissue, 4/43 (11.11%) from pus, and 4/43 (11.11%) from Broncho alveolar lavage (BAL). 8/43 (18.6%) cases were initially misdiagnosed clinically as tuberculosis without microbiological evidence, and were later identified as melioidosis. The mortality rate among the patients was 8/43 (18.6%), with the median time from onset of fever to death being 8 days (range 1–86 days). CONCLUSION: Clinical and laboratory diagnosis of melioidosis is challenging, more so in resource limited settings. Raising awareness among clinicians and microbiologists about the challenges in diagnosing and treating melioidosis is essential for ensuring timely diagnosis and prompt initiation of treatment. Epidemiology and Clinical Profile of Critically Ill Obstetric Patients Requiring ICU Admission – An Observational Tertiary Care Center Study in North India