Melioidosis in India: A systematic review of individual cases

Objectives Melioidosis is increasingly recognized in India, but available evidence remains fragmented across small reports. We aimed to synthesize national case-based data to describe the clinical spectrum and identify factors associated with mortality. Methods We systematically searched PubMed, Embase, and Web of Science from inception to February 5, 2025. Case reports, case series, and observational cohorts with individual patient-level culture- or molecular-confirmed data from India were included. Two reviewers independently screened studies, extracted data using a standardized form, and assessed quality using the Joanna Briggs Institute checklist for case reports. Univariate comparisons were performed between survivors and non-survivors. The protocol was registered on PROSPERO (CRD42025640317), and PRISMA guidelines were followed. Results From 1983 screened records, 209 studies reporting 558 cases from 20 states were included. The mean age was 44.8 years, and 73.4% had diabetes. Bacteremia occurred in 70.1%; pulmonary disease (33.2%), bone/joint involvement (35.1%), splenic abscesses (17.7%), and central nervous system disease (13.3%) were the most common conditions. Among 498 cases with reported outcomes, mortality was 19.9%. Malignancy, pulmonary and central nervous system involvement, and bacteremia were associated with death. Conclusions In India, melioidosis is widespread and often severe, with substantial mortality. Earlier recognition and improved diagnostic access are needed to reduce preventable deaths.