Melioidosis: An Indian Perspective

Melioidosis is caused by Burkholderia pseudomallei and is found in soil and water in tropical and subtropical regions of the world. The bacterium is capable of evading the host's immune system, leading to the development of acute, subacute, or chronic invasive infections or potentially entering a latent state that may persist for an extended period. The true burden of melioidosis is vastly underestimated. Hot and humid climates with extreme weather conditions and rainy seasons are linked to increased melioidosis cases. Rice fields, building construction workers working on the muddy soil, and barefoot walkers in the endemic areas acquire infection via inadvertent inhalation or inoculation. Over 80% of patients diagnosed with melioidosis exhibit associated comorbid conditions predisposing them to infections. The disease mostly mimics tuberculosis of any organ. The blood or abscess fluid culture continues to serve as the cornerstone of diagnosis. Intravenous therapy for 4 weeks (from 2 to 8 weeks) or until culture conversion is essential for individuals presenting with concurrent bacteremia and bilateral or unilateral multi-lobar pneumonia. The prolonged oral eradication therapy is also essential after intravenous therapy to prevent relapse. The overall mortality is very high due to delays in diagnosis and appropriate treatment, particularly in resource-poor areas.