Melioidosis in Brazil: An Underreported Disease with Growing Implications for Public Health

Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease with significant public health implications, historically considered endemic to Southeast Asia and Northern Australia. However, growing evidence highlights its underdiagnosed and underreported status in Brazil, where its true burden remains poorly characterized due to a lack of routine surveillance. This review explores the etiological agent, epidemiology, environmental determinants, clinical manifestations, diagnosis, treatment, and public health impact of melioidosis in Brazil. Reported cases show a strong concentration in the Northeast region, with sporadic cases in the Central-West, Southeast, and North, suggesting a wider distribution than previously recognized. Clinical presentations range from localized cutaneous lesions to fulminant septicemia. The disease is frequently misdiagnosed as tuberculosis, leptospirosis, or other bacterial infections due to non-specific signs and limited laboratory capacity. As climatic changes may lead to bacterial persistence, melioidosis has established itself as an emerging disease that has been expanding geographically in Brazil, requiring improved surveillance, diagnostic capacity, and clinician awareness, along with stronger laboratory infrastructure and access to appropriate antimicrobial therapy.