Comorbidities with Melioidosis in Indian context: A scoping review

Background and objectives Published literature from endemic countries such as Thailand and Australia identifies diabetes mellitus, alcoholism and chronic kidney disease as primary pre-existing factors for melioidosis. India, often referred as the global diabetic capital, has the predicted highest burden of melioidosis, yet well-designed prospective studies to analyse these risks remain limited. We conducted this scoping review to map the available Indian evidence on comorbidity patterns in melioidosis. Methods PubMed was searched for studies reporting melioidosis cases from India published between 1953 and May 2025 following PRISMA-ScR guidelines using predefined keywords. Studies conducted in Indian population which reported prevalence of pre-existing conditions or mortality outcomes in melioidosis were included, while case reports (≤2 cases) and small case series (3–9 cases) were excluded. Results From 336 records, 37 studies met inclusion criteria. After removing studies from same institute conducted in overlapping periods, 19 studies reported 1,317 patients with melioidosis. These studies were conducted in 11 Indian institutes, predominantly from southern India. Diabetes mellitus was the most prevalent [61.8%, 95% confidence interval (CI): 59.2-64.4] co-morbidity followed by alcoholism (15.5%. 95%CI: 13.5-17.4), and renal impairment (6.5%, 95% CI: 5.1-7.8). Only six studies evaluated the association of comorbidities with clinical outcomes. Interpretation and conclusions Diabetes mellitus was the most prevalent comorbidity among Indian melioidosis patients. Well-designed, prospective, multicentric studies are urgently needed to improve clinical recognition of melioidosis and guide targeted clinical interventions such as early diagnosis and timely initiation of appropriate therapy, along with public health measures including improved surveillance.