A 48-year-old man with uncontrolled diabetes developed persistent swelling in his left lower limb, followed by high fever and breathlessness. An ankle-joint sample was initially misidentified as Acinetobacter baumannii complex, while findings in his lungs raised suspicion of tuberculosis.
Cultures from his blood and joint pus eventually identified Burkholderia pseudomallei -- the bacterium that causes melioidosis. His blood cultures cleared around the 21st day of treatment, and he recovered, according to a case report described by Atish Mohapatra, Assistant Professor, Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar.In another report published in 2026, Dr.Mohapatra and colleagues described a 25-year-old patient living with sickle cell disease and type 1 diabetes who developed disseminated melioidosis involving the bones and lungs, with a splenic abscess and pulmonary embolism.Neha Rastogi Panda, senior consultant, Infectious Diseases, Fortis Hospital, described a case involving a 54-year-old man living with diabetes and chronic liver disease.
He had low-grade fever for about six weeks, followed by high fever over 15 days, and a persistent cough for three weeks. He also had swelling and pus discharge from his left foot.
A CT scan showed extensive consolidation in the right lower lobe of his lung. Blood cultures and samples collected during bronchoscopy grew B. pseudomallei, confirming pulmonary melioidosis with bloodstream infection.A study published in The Lancet Global Health, led by Nitin Gupta, Department of Infectious Diseases, 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%). Of those diagnosed, 50 (19.1%) died in hospital.
The infection and risksB. pseudomallei is found in soil and water in tropical and subtropical regions. Infection usually occurs when contaminated soil or water enters the body through cuts or wounds.
Inhalation of contaminated dust or water droplets and, less commonly, ingestion of contaminated water can also transmit the bacterium. Human-to-human transmission is exceptionally rare.
Melioidosis infection can occur through three main routes: inhaling contaminated dust or water droplets, drinking contaminated water, or contact with contaminated soil or water through cuts and open wounds. Rarely, transmission may occur from mother to child, including through breast milk, while person-to-person transmission is exceptionally uncommon | Photo Credit: Special Arrangement Melioidosis can cause pneumonia, bloodstream infection, skin and soft-tissue infections, abscesses in organs such as the liver and spleen, septic arthritis and bone infections.
It can also affect the kidneys, muscles and prostate. Rarely, infection involves the nervous system.
Severe disease can progress to septic shock and multiorgan dysfunction.Symptoms vary according to the organs affected. Patients may have persistent fever, cough, breathlessness, chest pain, weight loss, painful joint swelling, abdominal pain or localised skin infections.
Some develop a slowly progressive illness resembling tuberculosis, while others deteriorate rapidly. The infection can also relapse if treatment is inadequate.Diabetes is a major risk factor.
Chronic kidney, lung and liver diseases, heavy alcohol use and reduced immunity can also increase vulnerability. Dr.
Mohapatra says clinicians usually consider melioidosis in high-risk patients with unexplained sepsis, severe pneumonia, deep-seated abscesses or bone and joint infections, particularly when environmental exposure is plausible.Why diagnosis is delayedWhen it comes to diagnosis there are challenges at both the clinical and laboratory levels. Symptoms are often nonspecific, the disease can present in different ways and the incubation period can vary.
Clinicians may not suspect melioidosis or send appropriate samples for culture, while microbiologists may struggle to identify the organism correctly.Automated identification systems can help, but they are not infallible. Like in the above case, the bacterium was initially misidentified as A. baumannii complex.
Dr.Mohapatra notes that even systems such as VITEK 2 can misidentify B. pseudomallei. MALDI-TOF mass spectrometry can aid identification, but its cost and limited availability can be barriers.
Validated molecular tests, including PCR, can support confirmation where accessible.Culture of blood, pus, abscess aspirates, respiratory specimens or affected tissue remains central to diagnosis. Depending on the presentation, urine and other clinical samples may also be tested.
Multiple specimens may be necessary because infection can involve several organs, and prior antibiotic use can make confirmation difficult. Imaging with ultrasound, CT or MRI can help locate deep-seated abscesses and identify organ involvement.Madhumitha R., senior consultant, Infectious Diseases and Infection Control at MGM Healthcare, Chennai, says clinicians should consider blood cultures in patients with persistent fever, ideally before antibiotics when clinically appropriate.
If melioidosis is suspected, the laboratory should be informed so that appropriate identification procedures can be followed. A history of contact with contaminated soil or water can also help guide testing.Experts call for better communication between clinicians and microbiologists, training for laboratory personnel to recognise suspicious organisms, and referral pathways to facilities that can confirm difficult isolates.
Standardised laboratory procedures and quality assurance are important, particularly where advanced identification methods are unavailable.Treatment and surveillanceIndia’s National Centre for Disease Control provides technical guidance for melioidosis treatment in its 2025 manual on zoonotic diseases of public health importance. Treatment has two phases: an initial intensive phase with intravenous antibiotics, followed by prolonged oral eradication therapy to reduce the risk of relapse.Ceftazidime is an established option for the intensive phase, while meropenem is preferred in severe illness, including septic shock and neurological involvement.
Intravenous treatment may last two to eight weeks or longer, depending on severity and the organs affected. Bone and joint infections, neurological disease and deep-seated abscesses may require prolonged treatment.
The oral eradication phase commonly uses trimethoprim-sulfamethoxazole for several months, with longer courses sometimes required for complicated infections.Dr.Panda stresses that treatment must be individualised according to organ involvement, drug susceptibility, kidney and liver function, tolerability and clinical response. Drainage of accessible abscesses, control of underlying conditions such as diabetes, monitoring for adverse effects and follow-up after discharge are also important.
Incomplete treatment can lead to relapse even after symptoms improve. There is currently no licensed vaccine.The multicentre study found variation across participating centres, with the highest proportions in Odisha (26%), Madhya Pradesh (22.7%) and Karnataka (19.3%) – figures describe the selected hospital populations, not State-wide prevalence.
The study also found associations with monsoon admission, outdoor high-risk occupations and groundwater as the main drinking-water source. These associations do not establish causation.Earlier reviews have found confirmed cases in several Indian States, but differences in diagnosis, awareness and reporting may affect how many cases are recorded.
Dr. Mohapatra says India should move beyond identifying melioidosis only when an unusual case appears.
Experts recommend a phased surveillance system, beginning with hospitals and laboratories equipped to confirm infection and expanding as diagnostic capacity improves.Such a system could track confirmed cases, geographical and environmental exposures, antimicrobial susceptibility, treatment regimens, deaths, complications and relapse. Better surveillance, alongside improved diagnostic access and clinical awareness, would help establish the disease burden and guide public-health responses.Prevention is important especially for people who often come into contact with soil or water.
Farmers and others at higher risk should use protective footwear, cover cuts and abrasions, and clean contaminated wounds promptly. Avoiding untreated surface water and informing a doctor about possible environmental exposure may also help reduce risk and guide timely testing.Improving clinical awareness, access to reliable diagnostic testing and systematic surveillance will be essential to identifying more cases of melioidosis in India and reducing deaths from this potentially life-threatening infection.