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Melioidosis: A 5-year Review from a Single Institution in Pondicherry
Gadadhar Sharma1, Stalin Viswanathan2
1Additional Professor, JIPMER, Puducherry.
Introduction:
Forty-four percent of global cases are predicted to occur in the Indian sub-continent, but less than 2000 cases have been reported. Though the number of predicted cases in India is reported to be high, lesser numbers are being reported due to a lack of diagnostic capabilities and poor awareness of the disease.
Aims:
We aimed to estimate the number of cases of melioidosis over a 5-year period, the proportion of non-survivors, and map the geographical regions of the patients.
Methods:
Retrospectively, medical case records were reviewed with the search terms melioidosis and Burkholderia pseudomallei. Data on the geographical region, risk factors, clinical manifestations, and outcomes were collected and analysed.
Results:
Thirty-four patients with melioidosis were found. 12/34 had died in the hospital. Case records of only 20 patients (M=19, F=1) could be traced. Patients who died were older and had a longer duration of symptoms, had higher total leukocyte counts, higher platelet counts, and more severe hepatic and renal dysfunction compared to those who survived. Being a teetotaller, having received intensive care, and mechanical ventilation showed statistical significance between the two groups.
Conclusion:
Three centres from Pondicherry have reported melioidosis; this study had the most significant reported number of cases from a single institution in Pondicherry. The mapping of our patients resulted in probable evidence of melioidosis in six other districts of Tamil Nadu. Since the Indian population is at high risk because of diabetes, and melioidosis can mimic tuberculosis, increased awareness among physicians is a must to diagnose and treat this disease with high mortality.
Insights
Melioidosis, a serious bacterial infection, is underreported in India due to diagnostic challenges. This study identified 34 cases, highlighting the need for increased physician awareness and improved diagnostic capabilities for this high-mortality disease.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Melioidosis (caused by Burkholderia pseudomallei) is predicted to have high incidence in the Indian subcontinent, yet reported cases are low.
- Underreporting is attributed to limited diagnostic facilities and insufficient disease awareness.
Purpose of the Study:
- To estimate melioidosis case numbers over five years.
- To determine the proportion of non-survivors.
- To map the geographical distribution of patients.
Main Methods:
- Retrospective review of medical records using keywords 'melioidosis' and 'Burkholderia pseudomallei'.
- Data collection on patient demographics, risk factors, clinical presentation, and outcomes.
- Analysis of geographical regions, risk factors, clinical manifestations, and outcomes.
Main Results:
- 34 melioidosis cases identified; 12 (35%) patients died during hospitalization.
- Analysis of 20 traceable case records revealed older age, longer symptom duration, and severe hepatic/renal dysfunction in non-survivors.
- Teetotalism, intensive care, and mechanical ventilation were significant factors differentiating survivors and non-survivors.
Conclusions:
- This study reported the largest single-institution case series from Pondicherry, India.
- Geographical mapping suggested potential melioidosis presence in six additional Tamil Nadu districts.
- Increased physician awareness is crucial for diagnosing melioidosis, which mimics tuberculosis, in the high-risk diabetic Indian population.