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Peer-reviewedCC BYThe American journal of tropical medicine and hygiene

Computed Tomographic Features Associated with Pulmonary Melioidosis versus Pulmonary Tuberculosis in Diabetic Patients: A Retrospective Comparative Cohort Study.

  • Nitin Gupta1,2,3
  • Chiranjay Mukhopadhyay4
  • Tirlangi Praveen Kumar1
  • Kavita Salian1
  • Priya P S5
  • Sundeep Malla6
  • Rahul Magazine7
  • Steven Van Den Broucke2
  • Erika Vlieghe2,3,8
  • Emmanuel Bottieau2
8 affiliations
  1. 1Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
  2. 2Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
  3. 3University of Antwerp, Antwerp, Belgium.
  4. 4Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
  5. 5Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
  6. 6Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Faridabad, India.
  7. 7Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
  8. 8University Hospital Antwerp, Antwerp, Belgium.
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Abstract

Pulmonary melioidosis is frequently mistaken for pulmonary tuberculosis because of overlapping clinical and radiological features, often delaying appropriate treatment. We conducted a retrospective comparative cohort study at a tertiary care center in southern India between January 2018 and August 2025 to compare chest computed tomography (CT) features of microbiologically confirmed melioidosis and tuberculosis in diabetic adults who underwent CT within 30 days of symptom onset. A total of 151 patients were included: 46 with melioidosis and 105 with tuberculosis. Cavitation (n = 81/105 [77.1%] versus n = 20/46 [43.5%], P <0.001) and hydropneumothorax (n = 11/105 [10.5%] versus n = 0/46 [0%], P = 0.019) were more common in tuberculosis. In contrast, when compared with tuberculosis, melioidosis was associated with more frequent bilateral lung involvement (n = 37/105 [35.2%] versus n = 26/46 [56.5%], P = 0.015), pleural effusion (n = 28/105 [26.7%] versus n = 23/46 [50.0%], P = 0.005), and hilar lymphadenopathy (n = 6/105 [5.7%] versus n = 8/46 [17.4%], P = 0.032). Despite these differences, there was substantial overlap in CT findings, with upper-lobe predominance, centrilobular nodules, and mediastinal lymphadenopathy seen in both groups. In multivariable analysis, cavitation was associated with significantly lower odds of melioidosis than tuberculosis (adjusted odds ratio: 0.25, 95% CI: 0.12-0.54, P <0.001). Pulmonary melioidosis and pulmonary tuberculosis, therefore, show substantial overlap on chest CT in diabetic patients, and imaging should be interpreted as an adjunct to targeted microbiological diagnosis rather than a substitute for it.

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Cite

BibTeXRIS
BibTeX
@article{gupta2026computed,
  title = {{Computed Tomographic Features Associated with Pulmonary Melioidosis versus Pulmonary Tuberculosis in Diabetic Patients: A Retrospective Comparative Cohort Study.}},
  author = {Nitin Gupta and Chiranjay Mukhopadhyay and Tirlangi Praveen Kumar and Kavita Salian and Priya P S and Sundeep Malla and Rahul Magazine and Steven Van Den Broucke and Erika Vlieghe and Emmanuel Bottieau},
  journal = {The American journal of tropical medicine and hygiene},
  year = {2026},
  month = oct,
  doi = {10.4269/ajtmh.26-0337},
  url = {https://europepmc.org/article/MED/42869005},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Computed Tomographic Features Associated with Pulmonary Melioidosis versus Pulmonary Tuberculosis in Diabetic Patients: A Retrospective Comparative Cohort Study.
AU  - Nitin Gupta
AU  - Chiranjay Mukhopadhyay
AU  - Tirlangi Praveen Kumar
AU  - Kavita Salian
AU  - Priya P S
AU  - Sundeep Malla
AU  - Rahul Magazine
AU  - Steven Van Den Broucke
AU  - Erika Vlieghe
AU  - Emmanuel Bottieau
PY  - 2026
DA  - 2026/10/13
JO  - The American journal of tropical medicine and hygiene
DO  - 10.4269/ajtmh.26-0337
UR  - https://europepmc.org/article/MED/42869005
AB  - Pulmonary melioidosis is frequently mistaken for pulmonary tuberculosis because of overlapping clinical and radiological features, often delaying appropriate treatment. We conducted a retrospective comparative cohort study at a tertiary care center in southern India between January 2018 and August 2025 to compare chest computed tomography (CT) features of microbiologically confirmed melioidosis and tuberculosis in diabetic adults who underwent CT within 30 days of symptom onset. A total of 151 patients were included: 46 with melioidosis and 105 with tuberculosis. Cavitation (n = 81/105 [77.1%] versus n = 20/46 [43.5%], P <0.001) and hydropneumothorax (n = 11/105 [10.5%] versus n = 0/46 [0%], P = 0.019) were more common in tuberculosis. In contrast, when compared with tuberculosis, melioidosis was associated with more frequent bilateral lung involvement (n = 37/105 [35.2%] versus n = 26/46 [56.5%], P = 0.015), pleural effusion (n = 28/105 [26.7%] versus n = 23/46 [50.0%], P = 0.005), and hilar lymphadenopathy (n = 6/105 [5.7%] versus n = 8/46 [17.4%], P = 0.032). Despite these differences, there was substantial overlap in CT findings, with upper-lobe predominance, centrilobular nodules, and mediastinal lymphadenopathy seen in both groups. In multivariable analysis, cavitation was associated with significantly lower odds of melioidosis than tuberculosis (adjusted odds ratio: 0.25, 95% CI: 0.12-0.54, P <0.001). Pulmonary melioidosis and pulmonary tuberculosis, therefore, show substantial overlap on chest CT in diabetic patients, and imaging should be interpreted as an adjunct to targeted microbiological diagnosis rather than a substitute for it.
SN  - 0002-9637
SN  - 1476-1645
ER  -