Burkholderia pseudomallei-An Underrecognized Cause of Community-acquired Pneumonia: A Case Series from Central Kerala, India.

Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease endemic in several regions of the world, including India. It presents with a wide spectrum of clinical manifestations, among which pneumonia is the most common. Due to its clinical resemblance to bacterial pneumonia and pulmonary tuberculosis, coupled with limited access to advanced microbiological diagnostics, pulmonary melioidosis is frequently underdiagnosed. We report 3 culture-confirmed cases of pulmonary melioidosis from a tertiary care hospital in central Kerala. All patients were diabetic males, with additional comorbidities such as chronic obstructive pulmonary disease (COPD), chronic liver disease, anemia, smoking, and alcoholism. Notably, 2 had a prior history of pulmonary tuberculosis. Imaging revealed multifocal lung involvement, including consolidations, opacities, and cavitary lesions. Following microbiological confirmation, empirical therapy for community-acquired pneumonia (CAP) was modified to ceftazidime with or without cotrimoxazole. Despite intervention, 2 patients succumbed to the illness. This case series underscores the need for heightened clinical suspicion and robust microbiological support in diagnosing melioidosis. In high-risk patients presenting with multifocal pulmonary lesions, early modification of empirical antibiotic therapy may improve clinical outcomes and reduce mortality.