Melioidosis Cases Rising in India Amid Diagnostic Challenges

Melioidosis, caused by the bacterium Burkholderia pseudomallei, is increasingly recognized as a serious health threat in India. Recent reports indicate that many cases may remain undiagnosed or misdiagnosed, raising concerns about future outbreaks.

A 48-year-old man in Bhubaneswar, with uncontrolled diabetes, displayed symptoms such as swelling, high fever, and breathlessness. Initially, his infection was misidentified, but blood cultures eventually confirmed melioidosis after 21 days of treatment, leading to his recovery, according to Dr. Atish Mohapatra from Kalinga Institute of Medical Sciences.

In a separate case, a 25-year-old patient with sickle cell disease and diabetes suffered disseminated melioidosis, while a 54-year-old man presented with severe respiratory symptoms and was later diagnosed with pulmonary melioidosis at Fortis Hospital. Such varied presentations complicate diagnosis, often leading to errors.

A study published in The Lancet Global Health analyzed hospitalized patients across 15 Indian hospitals from January 2023 to December 2025, revealing a diagnosis rate of 8.9% among 2,953 patients tested. Of those diagnosed, 19.1% died while hospitalized.

Burkholderia pseudomallei thrives in tropical climates, with infection typically occurring through skin wounds or inhalation of contaminated dust. Symptoms range from pneumonia to severe organ abscesses, with diabetes and chronic diseases being significant risk factors. Dr. Mohapatra emphasizes the need for awareness among healthcare professionals regarding melioidosis, especially when patients present with unexplained septic conditions.

Diagnosis hinges on laboratory cultures of blood, pus, or tissue, yet challenges persist, including nonspecific symptoms and the bacterium’s potential misidentification. Experts suggest improved clinical and laboratory collaboration to enhance diagnostic accuracy. Automated systems sometimes fail to identify B. pseudomallei correctly, and while molecular tests can be effective, they are often limited in availability.

Dr. Madhumitha R. from MGM Healthcare stresses the importance of timely blood cultures in patients with persistent fever, recommending that laboratories be informed when melioidosis is suspected. A history of exposure to contaminated environments can guide diagnostic testing.

To combat the rising incidence of melioidosis, experts advocate for standardized case reporting, better training for laboratory personnel, and heightened awareness among clinicians to ensure that this potentially deadly infection is not overlooked.