Melioidosis in India: A systematic review of individual cases

Objectives: Melioidosis is increasingly recognized in India, but available evidence remains fragmented across small reports. We aimed to synthesize national case-based data to describe the clinical spectrum and identify factors associated with mortality. Methods: We systematically searched PubMed, Embase, and Web of Science from inception to February 5, 2025. Case reports, case series, and observational cohorts with individual patient-level culture- or molecular-confirmed data from India were included. Two reviewers independently screened studies, extracted data using a standardized form, and assessed quality using the Joanna Briggs Institute checklist for case reports. Univariate comparisons were performed between survivors and non-survivors. The protocol was registered on PROSPERO (CRD42025640317), and PRISMA guidelines were followed. Results: From 1983 screened records, 209 studies reporting 558 cases from 20 states were included. The mean age was 44.8 years, and 73.4% had diabetes. Bacteremia occurred in 70.1%; pulmonary disease (33.2%), bone/joint involvement (35.1%), splenic abscesses (17.7%), and central nervous system disease (13.3%) were the most common conditions. Among 498 cases with reported outcomes, mortality was 19.9%. Malignancy, pulmonary and central nervous system involvement, and bacteremia were associated with death. Conclusions: In India, melioidosis is widespread and often severe, with substantial mortality. Earlier recognition and improved diagnostic access are needed to reduce preventable deaths.