Emerging clinico-epidemiological trends in melioidosis: Analysis of 95 cases from western coastal India

Objectives: To study the clinico-epidemiological trends in melioidosis, an emerging disease in the western coastal region of India. Methods: Data of 95 patients with melioidosis in the western coastal region of India were retrospectively analyzed with respect to monthly rainfall, risk factors, clinical presentations, and outcome. Results: A strong linear correlation was seen between average monthly rainfall and the occurrence of cases (p= 0.002). Mortality was seen only in patients with bacteremia (p< 0.001). Nine (40.9%) patients with septic shock died (p< 0.001). Age ≥40 years and diabetes mellitus were seen in 75.8% of cases, each. Pneumonia was the most common clinical presentation (32.6%), followed by musculoskeletal disease (20%), melioidotic lymphadenopathy (7.4%), and dental abscess (6.3%). Only 36.8% of patients had exposure to wet soil/surface water. Conclusions: Melioidosis is quite prevalent in the western coastal region of India, and is strongly associated with rainfall, age, and diabetes mellitus. Higher proportions of musculoskeletal, dental, and lymph node melioidosis were seen in this region as compared to endemic areas. Bacteremic melioidosis has a poorer prognosis than non-bacteremic melioidosis. The presence of septic shock is a strong predictor of mortality. Percutaneous inoculation may not be the main portal of entry for Burkholderia pseudomallei in this region.