Missing links of melioidosis in India: A cross-sectional analysis of case reports, agro-meteorological and socioeconomic factors

Melioidosis, an emerging tropical infectious disease and a global threat, lacks a disease prediction model owing to the suboptimal information related to the incidences and associated factors. This article focusses on spatial data analysis of melioidosis patients in India, a tropical country considered to be endemic for the disease. In this study, we screened over 20,000 articles and identified 1,694 patients diagnosed with melioidosis in India between 1953 and 2023. We performed a correlative analysis of patient profiles, case-reporting centers, common misdiagnosed etiologies, susceptible populations, agro-meteorological and socioeconomic factors. Our findings suggest that melioidosis can affect individuals of all ages, with a higher prevalence among farmers and individuals with diabetes mellitus, particularly those aged 40 to 55 years. Most cases are reported during the monsoon season (June to September). Despite the presence of numerous favorable conditions for Burkholderia pseudomallei growth across India, most reported cases are concentrated in southern India, suggesting significant under-reporting, under-diagnosis, or misdiagnosis of the disease. A "melioidosis checklist index" is developed that could improve case reporting. The study also emphasized the importance of strengthening regional data collection by increasing awareness among susceptible populations, healthcare providers, and paramedical staff.