Melioidosis: An underdiagnosed disease in India (epidemiology, clinical features, and outcomes)

Background: Melioidosis is an emerging infectious disease in Southeast Asia. It is an under diagnosed and under reported disease in India mostly because of lack of awareness. Objective: We studied the clinical profile and outcome of melioidosis. Methods: A prospective observational study conducted at Kasturba Hospital, Manipal University from May 2007 to July 2009. Results: There were 31 diagnosed patients in all. Diabetes mellitus was the most common risk factor (68%). Eighty-one percent of cases were detected in the rainy season. Male to female ratio was 3:1. The median age was 48 years. Fifty-two percent of patients were in the age group 41 to 60 years. Thirty-two of patients were agriculturists. Respiratory symptoms were the predominant presentations. The majority (87%) of patients had fever. The bacteria were sensitive to ceftazidime, cotrimoxazole, carbapenems, piperacillin, doxycycline, and chloramphenicol, and resistant to aminoglycosides. Forty-eight percent of patients had bacteremia. Forty-five percent of cases were cured. Twenty-percent of patients had septicemia and septic shock. Sixteen percent of patients died because of septic shock. Conclusion: Melioidosis is very difficult disease to diagnose clinically and to treat; mostly because of varied presentations. Awareness of the existence of this disease in an endemic region with various underlying risk factors is essential for successful treatment. The early use of appropriate antibiotics and the efficient care of patients with sepsis improves outcomes dramatically. Patients with septicemia and septic shock still result in high mortality rates in spite of efficient critical care.