Background Melioidosis, caused by the environmental bacterium Burkholderia pseudomallei, is an oftenfatal infectious disease with a high prevalence across tropical areas. Clinical presentation can vary from abscess formation to pneumonia and septicaemia. We assessed the global burden of melioidosis, expressed in disability-adjusted life years (DALYs), for the year 2015. Methods A systematic review of the peer-reviewed literature for human melioidosis cases between 1990 and 2015 was performed. Using a broad search strategy, no language restrictions and combinations of search terms, Burkholderia spp. and disease names, all relevant articles were screened on title, abstract, and full text. Quantitative data from cases including mortality, age, sex, infectious and post-infectious sequelae, antibiotic treatment and symptom duration were extracted. This information was then combined with established disability weights and expert panel discussions to construct an incidence-based disease model. The disease model was integrated with established global incidence and mortality estimates to calculate global melioidosis DALYs. Findings 2 888 articles were screened, of which 475 eligible studies containing quantitative information were retained. Sepsis/septic shock and pneumonia were the most common outcomes, occurring in 18.0% (1526/8469), 12.1% (1004/8298) and 35.7% (3633/10175) of patients respectively. The male to female ratio of infection was 2:1. We estimate that in 2015, the global burden of melioidosis was 4•6 million DALYs (UI 3•2-6•6) or 84•3 per 100 000 people (UI 57•5-120•0). Years of life lost (YLL) accounted for 98•9% (UI 97•7-99•5) of the total DALYs. Interpretation Our estimates enable comparison with other tropical diseases which are already recognised as neglected and give policy makers the information necessary to reconsider melioidosis as a major neglected tropical disease.

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