Meliodosis risk factors, Udupi, India, 2018

We initiated an epidemiological investigation following the death of a
previously healthy 17 year-old boy with neuro-melioidosis. A case was
defined as a culture-confirmed melioidosis patient from Udupi district
admitted to hospital A from January 2013 - July 2018. For the case control
study, we enrolled a subset of cases admitted to hospital A from January
2017- July 2018. A control was resident of Udupi district admitted to
hospital A in July  2018 with a non-infectious condition. Using a
matched case-control design, we compared each case to 3 controls using age
and sex groups. We assessed for risk factors related to water storage,
activities of daily living, injuries and environmental exposures (three
months prior to hospitalization), using conditional regression analysis.
We identified 50 cases with case fatality rate 16%. Uncontrolled diabetes
mellitus was present in 84% cases and 66% of cases occurred between May
and October (rainy season). Percutaneous inoculation through exposure to
stagnant water and injury leading to breakage in the skin were identified
as an important mode of transmission. We used these findings to develop a
surveillance case definition and initiated training of the district
laboratory for melioidosis diagnosis.