Melioidosis in South Asia: Scientific Advances, Regional Challenges and One Health Perspectives—An Integrated Research Synthesis from the 4th South Asian Melioidosis Congress

Background Melioidosis, caused by Burkholderia pseudomallei , is a severe tropical infection with diverse clinical manifestations and high mortality if untreated. Although endemic in Southeast Asia and northern Australia, its burden is increasingly recognized in South Asia, where the disease remains underdiagnosed and is frequently misclassified as tuberculosis or other infections. This review synthesizes the contemporary scientific evidence and expert consensus emerging from the 4th South Asian Melioidosis Congress held in Guwahati, Assam, India, in November 2025. Methods We conducted an integrated narrative synthesis of the scientific content presented at the Congress, including plenary lectures, oral and poster presentations, panel discussions, and case-based deliberations. Topics encompassed epidemiology, clinical manifestations, laboratory diagnostics, genomics, treatment strategies, outbreak investigations, antimicrobial resistance, and One Health perspectives across South and Southeast Asia. Results The Congress highlighted expanding geographic recognition of melioidosis across India and neighbouring countries, with reported cases likely representing only a small fraction of the true disease burden. Clinical discussions emphasized marked heterogeneity in presentation and strong associations with diabetes mellitus, environmental exposure, and the monsoon season. Advances in diagnostics included broader implementation of MALDI-TOF mass spectrometry, molecular assays, and rapid diagnostic tests, although significant gaps remain in laboratory capacity, surveillance, and clinical recognition. Genomic investigations demonstrated substantial strain diversity while identifying conserved virulence determinants that may support surveillance and outbreak investigations. Participants also underscored the importance of multidisciplinary collaboration, standardized diagnostic practices, and regional data sharing to improve case detection and patient outcomes. Conclusions Melioidosis remains an underrecognized but increasingly important public health challenge in South Asia. Strengthening surveillance systems, expanding diagnostic capacity, improving clinician awareness, fostering regional laboratory networks, and adopting coordinated One Health strategies are essential to reduce morbidity and mortality. The Congress also reinforced the need for sustained advocacy toward recognition of melioidosis as a neglected tropical disease.