# Pediatric Melioidosis in Central India: A Clinico-Epidemiological Study From a Landlocked Region

## TL;DR

This study reports rare pediatric cases of melioidosis in central India, showing varied symptoms and highlighting the disease's expanding geographic and age-related patterns.

## Contribution

The study provides the first detailed clinico-epidemiological data on pediatric melioidosis in central India, a non-endemic region.

## Key findings

- Seven pediatric melioidosis cases were identified over six years in central India.
- Common presentations included pneumonia, visceral abscesses, and lymphadenitis.
- Two children died despite no known comorbidities, emphasizing the disease's severity in pediatric cases.

## Abstract

Objective

Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease in India but remains less common in children compared with adults. Most studies are reported from southern and eastern coastal states, with limited data from central India, a landlocked, traditionally non-endemic region.

Materials and methods

We conducted a part-retrospective, part-prospective study at a tertiary care institute in central India between January 2020 and September 2025. The study included all patients aged ≤16 years with isolation of B. pseudomallei in clinical samples. The clinico-epidemiological and laboratory data were obtained from medical records, and patients were followed up prospectively to know the outcome. Identification was performed using Vitek®-2 Compact till 2022 and later all the isolates were confirmed by Vitek® MS Prime (both bioMérieux, Marcy-l'Étoile, France). Antimicrobial susceptibility was determined by the Kirby-Bauer method following European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.

Results

Among 132 confirmed melioidosis cases, a total ofseven (5%) pediatric melioidosis cases were identified over a six-year period. The most common clinical presentation was pneumonia in three (42%), visceral organ abscess in two (28%), soft tissue abscesses in two (28%) followed by lymphadenitis in one (14%) and neurological involvement in one (14%) case. Two cases had multisystemic involvement. None of the patients had diabetes, while three (42%) had other comorbidities. Two (28%) children succumbed despite no known comorbidities, while the remaining improved with standard treatment for melioidosis.

Conclusion

Melioidosis presents with varied clinical manifestations in pediatric patients and should be considered in the differential diagnosis in patients with pneumonia, visceral abscesses and lymphadenitis, even in the absence of traditional risk factors. The emergence of pediatric cases in a non-coastal, central Indian region indicates a shift in epidemiological pattern and highlights the need for increased clinical vigilance. Early diagnosis and timely treatment remain essential to reduce mortality.