Melioidosis in India: Epidemiological Insights and Predictions from 20-Year Review of Literature with Note on Inclusive Capacity Building

Background: Melioidosis caused by the infamous soil pathogen, Burkholderia pseudomallei could have lethal outcome in patients with diabetes or any other chronic illness-like kidney or liver disease. Unfortunately, it being spread through contaminated soil and water makes farmers and children prone to the diseases. Its higher prevalence in monsoon periods, floods, tsunamis make it an important disease in India. Objective: To present an overall view of Melioidosis in India in last 20 years and future perspectives. Methods: This article of ours focuses on literature retrieved from Pub Med (2004-2024) with two search criteria “Melioidosis prevalence India” and “Melioidosis risk factor India” and presented on the basis of – geographical location of Study site, environmental surveillance, clinical data, outbreak surveillance, risk factors, type of study, data pertaining to drugs, vaccine, diagnostics, novel therapy, medical practice and general lab diagnosis. Results: In general, the number of publications from the Southern India on Melioidosis was highest followed by the East. Publications of review articles were mostly on clinical- epidemiological studies followed by other studies on environmental surveillance or outbreak surveillance.  It was also observed from studies spanning from 2010-2022 in India that the symptoms observed in Melioidosis patients included fever that accounted for 86% (SD 12%), Cough that accounted for 26% (SD17%), Joint Pain 23% (SD 21%). The % of pre disposing factors averaged from 9 studies, included Diabetes 75% (SD 9%); Alcohol abuse 19% (SD 9%); Cancer 6% (SD 1%). Clinical presentation included bacteremia 50% (SD 38%); skin and soft tissue involvement 16% (SD 10%); Pneumonia 37% (SD 23%); Splenic abscess 18% (SD16%). In studies from 2012 and 2021, it has been noticed that risk due to environmental exposure has not been significantly high in India and people working outdoor and indoor in varied professions are prone thus delineating the risk to diabetes, lifestyle factors.  Conclusion: Using Diabetes and Poverty hotspots for presumed geographical mapping of melioidosis prone states, districts in India could possibly aid in better identification and control of the disease. Further, from this review study, it is noted that the awareness on melioidosis has increased over the last two decades. Publications on Melioidosis were mostly on clinical epidemiology studies and then followed by publications on anti-microbial susceptibility, vaccines, diagnostics, and environmental risks. Studies indicate that owing to out-of-pocket expense, Ceftazidime was seen to be preferred than Carbapenem in the following states from high to low preference: Tamil Nadu, Kerala, Goa, Jharkhand, Karnataka, Telangana and West Bengal. This could be further examined.