Clinical Spectrum and Outcomes of Melioidosis: An Eight-Year Study

TL;DR

This study examines the clinical features and outcomes of melioidosis in South India, highlighting its severity and the importance of early diagnosis.

Contribution

The study provides insights into the clinical spectrum and risk factors of melioidosis in a South Indian population.

Findings

Melioidosis showed a strong male predominance with a mean age of 43 years.

Diabetes mellitus was the most common comorbidity, and fever was the most frequent symptom.

The in-hospital mortality rate was 29.4%, with higher mortality among older patients and those with diabetes.

Abstract

Objective

This study aimed to describe the clinical spectrum, demographic characteristics, risk factors, and treatment outcomes of patients with culture-proven melioidosis at a tertiary care center in South India.

Materials and methods

We conducted an eight-year retrospective study from September 2004 to August 2012. This study included all inpatients with clinical samples culture-positive for Burkholderia pseudomallei. Data on demographics, presentation, comorbidities, management, and outcomes were collected from medical records. All patients received a standardized antibiotic regimen.

Results

Among 34 culture-proven patients, melioidosis showed a strong male predominance (28, 82.4%), with a mean age of 43 ± 14.8 years. Diabetes mellitus (DM) was the most common comorbidity (24, 70.6%). Fever was the most common symptom (30, 88.2%), with musculoskeletal infection (12, 35.3%), particularly septic arthritis (11, 32.4%), as the most frequent focal manifestation. Bacteremia was present in 19 (55.9%) of the cases. The in-hospital mortality rate was 29.4% (10), with trends suggesting higher mortality among older age groups and those with diabetes and jaundice.

Conclusion

Melioidosis presents as a severe, systemic infection with significant mortality in this region of India. A high index of suspicion is essential for early diagnosis, especially in patients with DM, fever, and abscesses. The disease often mimics tuberculosis, which complicates diagnosis. The recommended antibiotic regimen was effective for most patients, highlighting the importance of timely and appropriate antimicrobial therapy to improve outcomes. Increased physician awareness and prompt laboratory support are crucial for early recognition and management.

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