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

## TL;DR

This study identifies risk factors for acute respiratory distress syndrome in patients with pulmonary melioidosis, a severe lung infection caused by a tropical bacterium.

## Contribution

The study reveals that excessive alcohol consumption and low BMI are novel predictors of ARDS in pulmonary melioidosis patients.

## Key findings

- 36 patients with pulmonary melioidosis were identified, with 83.3% developing acute respiratory failure requiring ventilation.
- Excessive alcohol consumption and BMI < 20 kg/m² were significantly associated with ARDS development.
- The overall mortality rate was 55.6%, with no significant difference between ARDS and non-ARDS patients.

## Abstract

Pulmonary melioidosis, caused by Burkholderia pseudomallei, emerges as the most prevalent and highly fatal manifestation of melioidosis. Despite being a global health concern, pulmonary melioidosis remains insufficiently studied and reported.

Whether patients with pulmonary melioidosis have any potential characteristics or specific risk factors that are associated with their respiratory outcome’s trajectory.

A 5-year retrospective cohort study was conducted. Electronic medical records of patients admitted for Burkholderia pseudomallei pneumonia between January 1, 2019 and December 31, 2023, at Chaophraya Abhaibhubejhr hospital, Prachinburi, Thailand were reviewed.

Of 1,486 adults admitted with bacterial pneumonia, 36 patients (2.4%) were diagnosed with microbiologically confirmed pulmonary melioidosis. Thirty of 36 patients (83.3%) developed acute respiratory failure requiring mechanical ventilation within 24 hours after admission. Twenty-three of 36 (63.9%) met the 2024 global definition of acute respiratory distress syndrome (ARDS) with 78% being moderate-to-severe ARDS. Pulmonary melioidosis with ARDS was associated with excessive alcohol consumption (p = 0.013) and body mass index (BMI) < 20 Kg/m2 (odds ratio of 6, 95%CI 1.080-33.321, p = 0.041) when compared to non-ARDS. BMI < 20 Kg/m2 was also associated with ARDS development, independent of age (odds ratio of 29.27 (95%CI 1.849 – 463.678, p = 0.017). The overall mortality rate of pulmonary melioidosis was 55.6%, with no differences between patients with ARDS and non-ARDS (65.2% vs 38.5%, respectively; p = 0.169).

ARDS frequently emerges in patients with pulmonary melioidosis requiring invasive mechanical ventilation and intensive care support. Excessive alcohol consumption and a low BMI status were associated with the development of ARDS in these patients.

Melioidosis is a tropical infectious disease caused by Burkholderia pseudomallei. The diagnosis is confirmed by the growth of B. pseudomallei. Pulmonary melioidosis is the most common organ involvement of melioidosis with a high fatal rate. Acute respiratory distress syndrome (ARDS) is life-threatening lung injury characterized by poor oxygenation and non-compliant (stiff) lungs. Poor outcome has been reported in pulmonary melioidosis with ARDS. We aimed to identify clinical characteristics and potential risk factors between patients with pulmonary melioidosis with and without ARDS. Our study demonstrated that excessive alcohol consumption and a low BMI status in patients with pulmonary melioidosis could predict the development of ARDS.