Pulmonary melioidosis: an experience over years from a tertiary care hospital from southwest India

Background: Melioidosis is endemic in northern Australia, South and South East Asia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. Our aim was to study the clinical, radiological and laboratory presentations of pulmonary melioidosis and compare them with other sporadic cases reported from India. Method: This prospective, hospital based study was conducted during 2007 to 2015 in a tertiary care hospital situated in southern India. Diagnosis of melioidosis was confirmed by isolation of B. pseudomallei from any of the sterile or unsterile sites. Patients’ details like baseline demography, possible risk factors, clinical and radiological presentations, laboratory features, treatment and outcome were documented. Results: A total of 65 (65/148, 43.9%) culture confirmed cases of pulmonary melioidosis were diagnosed in eight years, most of which (80%) were acute. Majority of the patients were male (85%). Most of the patients presented with fever (91%) and productive cough (78.4%). The most common radiological feature was consolidation of the upper lobe (26.3%). There were 2 cases of co-infection with pulmonary tuberculosis, which were subsequently treated for dual infection. The most common drug of choice was ceftazidime (49%). Overall mortality rate was 21%, significantly associated with sepsis, septic shock, organ dysfunction and bacteraemia. Conclusion: Acute pulmonary melioidosis should be kept in mind by clinicians whenever a patient of acute clinical deterioration presents with symptoms and radiological diagnosis similar to tuberculosis.