Melioidosis–Tuberculosis Cytokine Profiling Study

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This study investigated systemic cytokine responses in adults with acute melioidosis and pulmonary tuberculosis (PTB) in an endemic region of southern India (2021–2024). A total of 64 participants were enrolled and stratified into six groups: melioidosis with diabetes mellitus (DM) (n=8), melioidosis without DM (n=8), PTB with DM (n=8), PTB without DM (n=8), DM controls without acute infection (n=16), and non-diabetic healthy controls (n=16). Melioidosis was confirmed by culture isolation of Burkholderia pseudomallei from clinical specimens. PTB was diagnosed by sputum smear positivity (≥3+) and detection of Mycobacterium tuberculosis using Xpert MTB/RIF. Diabetes status was defined according to WHO criteria. Plasma samples were collected at hospital admission for assessment of immune responses. Figure 1: Clinical profile comparison between melioidosis and PTB patients. Data are presented as the percentage of patients exhibiting specific symptoms. Statistical comparisons were performed using chi-square analysis. Figure 2: Plasma cytokine profiles across melioidosis (n=16), PTB (n=16), and control groups (n=32). Cytokines were measured using a Human Cytokine Magnetic 10-plex multiplex Luminex assay (MAGPIX platform). Concentrations are expressed in pg/mL. Figure 2A shows a heatmap of log10-transformed median cytokine concentrations across groups. Figures 2B–E present plasma levels of Galectin-3 (Gal-3), hepatocyte growth factor (HGF), IL-6, and IL-8. Data are displayed as median with interquartile range (IQR). Statistical comparisons were performed using the Kruskal–Wallis test with Dunn’s post hoc correction. Figure 3: Receiver operating characteristic (ROC) curve analysis evaluating the discriminatory performance of Gal-3, HGF, IL-6, and IL-8. Area under the curve (AUC) values are shown for melioidosis versus controls, PTB versus controls, and melioidosis versus PTB. Figure 4: Principal component analysis (PCA) of clinical and cytokine variables across melioidosis, PTB, and control groups. ROC analysis of predictive models is also shown, including Model 1 (cytokines only), Model 2 (clinical parameters only), and Model 3 (combined cytokine and clinical parameters), with corresponding AUC values.