Clinical profile, susceptibility patterns, treatment and outcomes of melioidosis in India.

Background: Melioidosis, caused by Burkholderia pseudomallei, is endemic to India and has been associated with significant morbidity and mortality. Since it mimics several other diseases, it is grossly under-recognised. This study was undertaken to describe the clinical manifestations, drugsusceptibility and outcomes of melioidosis in India. Methods & Materials: We carried out a retrospective study of adult patients admitted with culture proven melioidosis ina tertiary care hospital in South India from 2008 to 2014. Results: 114 patients, with a mean age of 45 years (92% males) were included. The patients were from 15 states, majority being from West Bengal (26.3%), Jharkhand (22.8%) and Tamil Nadu (14.9%). Common risk factors included diabetes (82.3%), and alcoholism (14%). The mean duration of symptoms, commonly fever, was 4 months and majority (78%) had multifocal disease. Patients presented in the cooler months (80.5%), especially in the acute group. Chronic melioidosis was commoner than acute disease (64% vs 36%). 11 patients (15%) among chronic melioidosis presented with an acute worsening and bacteremia. Bacteremia (80% vs 41%) and respiratory involvement (39% vs 16%) were more common in acute disease. Chronic granulomatous disease was associated with splenic (50% vs 29%), genitourinary (17.8 vs 4.9%) and bone involvement (12.3 vs 7%). Drug susceptibility to Carbepenems was 100%, Ceftazidime 98.1% while resistance to Trimethoprim-Sulfamethoxazole and Doxycycline was 5.9% and 2.6%. Our patients received induction therapy with Ceftazidime or Meropenem followed by eradication treatment with Trimethoprim-Sulfamethoxazole and Doxycycline. 50.9% patients required a surgical intervention and 21.9% were admitted to an intensive care unit. The case fatality rate was 14.9%. Bacteremia (p <0.001) and respiratory involvement (p=0.003) were associated with increased mortality. 57.9% patients were followed up and 3.5% patients had a relapse. Conclusion: Melioidosis is an emerging infection in India. Majority of the patients are diabetics presenting with chronic granulomatous disease. Patients with septicemia and respiratory involvement had poorer outcome. A high index of suspicion in the appropriate clinical setting, and early initiation of therapy are essential. [ABSTRACT FROM AUTHOR]