Risk Factors for Melioidosis in Udupi district, Karnataka, India, January 2017-July 2018

  • Vaccine preventable diseases
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Background:
Melioidosis is fatal bacterial illness, affecting both humans and animals, and a potential biological weapon. Annually, 44% of an estimated 165,000 cases globally occur in South Asia. Suitable environmental conditions and high burden of diabetes, a predisposing risk factor, makes India a hotspot. The death due to melioidosis of a 17-year-old boy in July 2018 in Udupi district prompted us to conduct a wider study of melioidosis incidence and risk factors.

Methods:
We defined a case as resident of Udupi district diagnosed with Burkholderia pseudomallei by culture, confirmed by polymerase chain reaction during January 2017-July 2018. We identified cases from hospital records. We selected three gender and diabetes status-matched controls per case from patients hospitalized for non-infectious conditions during the same period. Socio-demographic and exposure data were collected from medical records and interviews. Matched odds ratios (mORs) with 95% confidence intervals (CI) were calculated using conditional logistic regression.

Results:
We identified 19 cases, 74% males with median age 56 years (range 17-83 years). Most (90%) cases occurred during rainy season. Among cases, 83% were diabetics; overall case fatality rate was 37%. Common presentations were fever (89%), cough (42%), joint pain (37%), and soft tissue swellings (14%). Among cases and controls (19:57), exposures such as contact with stagnant water (mOR 25.0; 95% CI: 3.2-196.4), working in paddy fields (mOR 24.0; 95% CI: 3.0-186.8), presence of collected rainwater around house (mOR 7.8; 95% CI: 2.0-29.3) and cuts/abrasion due to injuries (mOR: 5.3; 95% CI: 1.6-17.7) were significantly associated with melioidosis.

Conclusion:
Melioidosis occurred among older diabetic males. Prolonged contact with stagnant water during routine or agricultural activities and open injuries were associated with acquiring melioidosis. We recommended sensitization of diabetic patients to use hand and foot protection such as gloves and gum boots during rainy season and for agricultural activities.

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