Study finds nearly 1 in 11 high-risk hospitalised adults in India had melioidosis, with high in-hospital deaths

Key facts

• A multicentre study published in The Lancet Global Health, led by Nitin Gupta of Kasturba Medical College, Manipal Academy of Higher Education, assessed high-risk hospitalised adults at 15 Indian tertiary-care centres between January 2023 and December 2025.
• Culture-confirmed melioidosis was found in 262 of 2,953 patients (8.9%), and 50 of those diagnosed (19.1%) died in hospital.
• The study found the highest proportions of confirmed cases in Odisha (26%), Madhya Pradesh (22.7%) and Karnataka (19.3%), though these figures describe selected hospital populations, not State-wide prevalence.
• The study found associations between melioidosis and monsoon admission, outdoor high-risk occupations and groundwater as the main drinking-water source, though these do not establish causation.
• Melioidosis is caused by Burkholderia pseudomallei, a bacterium found in soil and water in tropical and subtropical regions, which enters the body through cuts or wounds, inhalation of contaminated dust or droplets, or ingestion of contaminated water.
• Diabetes is a major risk factor for melioidosis, while chronic kidney, lung and liver diseases, heavy alcohol use and reduced immunity also increase vulnerability.
• Melioidosis treatment has two phases: an initial intensive phase with intravenous antibiotics such as ceftazidime (meropenem preferred in severe illness), followed by prolonged oral eradication therapy commonly using trimethoprim-sulfamethoxazole for several months.
• India's National Centre for Disease Control provides technical guidance for melioidosis treatment in its 2025 manual on zoonotic diseases of public health importance.
• There is currently no licensed vaccine against melioidosis.
• Diagnostic challenges include nonspecific symptoms and misidentification of B. pseudomallei by automated systems such as VITEK 2, while MALDI-TOF mass spectrometry can aid identification but faces cost and availability barriers.
• Experts recommend a phased surveillance system beginning with hospitals and laboratories equipped to confirm melioidosis, tracking confirmed cases, exposures, antimicrobial susceptibility, treatment outcomes, deaths and relapse.