For years, health officials in the US noted sporadic, mysterious cases of a foreign bacterial infection called melioidosis. The infection – which is difficult to diagnose, difficult to treat and often fatal – would only affect travelers or those who came into contact with contaminated imported goods or animals. Still, every now and then an American would inexplicably get sick — no recent travels, no obvious connections.
Now health officials have a definitive statement. And it confirms a feared, long-held suspicion: the deadly bacteria is no longer strange. Rather, it is a permanent resident of the US, anchored in US soil.
Three samples taken from soil and pool water in the Gulf Coast region of southern Mississippi tested positive for the bacteria, officials with the Centers for Disease Control and Prevention announced Wednesday. The sampling was part of an investigation into two mysterious cases in the area that occurred in 2020 and 2022. The positive test results mark the first time researchers have caught the deadly germ in U.S. environmental samples, even though they’ve been looking for it for years. year.
It’s unclear how long the bacterium has lived in the US or how widespread its spread has become. But CDC modeling suggests that the environmental conditions of the Gulf Coast states are conducive to the bacteria’s growth. The agency has called for extensive environmental sampling.
While the finding explains the puzzling cases, the most important thing now is for health officials to get the word out. This is no longer a traveler’s disease. In a health advisory released yesterday, the CDC emphasized that its notice “serves to alert clinicians and public health officials across the country to consider melioidosis in patients whose clinical presentation is consistent with signs and symptoms of the disease, regardless of travel history.” to international disease-endemic regions, as melioidosis is now considered locally endemic in areas of the Gulf Coast region of Mississippi.”
New inhabitant
The bacteria at hand is Burkholderia pseudomallei, which lives in the soil and water of tropical and subtropical regions and causes rare but dangerous sporadic infections. The areas of highest endemity are in Southeast Asia and Northern Australia, but it has also cropped up in areas of Southwest Asia, Africa, the Pacific, and the Americas such as Peru, Brazil, Haiti, and some U.S. territories, including Puerto rico.
B. pseudomallei causes melioidosis by transmitting in a variety of ways, all involving direct contact with contaminated soil and water. People can become infected if they ingest contaminated soil, water or food; if they inhale contaminated dust or water droplets; or if contaminated soil or water comes into contact with a break in the skin. The people who are more at risk for melioidosis than others are those with specific conditions, such as diabetes, heavy alcohol use, chronic lung disease, chronic kidney disease, and conditions that weaken the immune response. One bit of good news is that the infection is rarely passed from person to person.
The resulting symptoms of melioidosis may depend on which pathway B. pseudomallei absorbs into the body. If it enters through a skin wound, it can cause pain, swelling, and an abscess. If it gets into the blood, it can cause joint pain, abdominal pain and disorientation. If it enters through the lungs, it can cause coughing and chest pain. And if it becomes systemic, it can cause weight loss, brain infection, and seizures. In general, the symptoms can seem vague and can be easily mistaken for other conditions. It has been described as “the great mimic” because of how often and easily it is mistaken for other serious infections, such as tuberculosis.
His obscure nature contributes to his lethality. B. pseudomallei is naturally resistant to many commonly used antibiotics. Any delay in an accurate diagnosis can allow the bacteria to cause more serious illness. According to the CDC, melioidosis is fatal in 90 percent of people not treated properly. When people are treated with the right antibiotics, the death rate drops below 40 percent. And if patients have access to intensive care and the right drugs, the death rate drops to about 20 percent.
For all these reasons, the US government believes: B. pseudomallei a threat of bioterrorism, listing it along with anthrax bacteria as a Tier 1 Select Agent (Bacillus cereus Biovar anthracite) and the Ebola virus.
American cases
According to the CDC, there are an average of about 12 cases of melioidosis per year in the US, most of which were travel-related. But there have been notable and puzzling exceptions over the years.
Last year, melioidosis made headlines when four people in four states became infected with the same strain of ? B. pseudomallei. The first unexplained cases, which were fatal, occurred in March in an adult in Kansas. Then another adult in Minnesota survived, and a 4-year-old in Texas was left with brain damage. Finally, a child in Georgia was identified as a case through an autopsy.
In October, researchers announced a break in the enigmatic outbreak: the strain of B. pseudomallei that caused the infections was found in an aromatherapy room spray, made in India, that contained “gems.” In particular, it was the Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones, which Walmart sold.
Though researchers suspected an imported product from the start, the cluster drew attention to other puzzling cases in the US — cases that had raised concerns that B. pseudomallei was lurking on American soil. For example, in 2015, researchers at the CDC examined the 34 cases of melioidosis in humans in the U.S. between 2008 and 2013, and found that the number of cases seemed to be increasing every year during that period. The study, published in the CDC’s Morbidity and Mortality Weekly Report, concluded that: B. pseudomallei may be an emerging infectious disease in the US.
“Note: Three cases of melioidosis occurred in U.S. residents with no history of travel outside the United States or to regions where melioidosis is endemic, possibly indicating unrecognized sources of exposure in the United States,” the researchers wrote. “Therefore, knowing that this infection can be seen in individuals without a clear history of traveling to locations where” B. pseudomallei endemic is important.”
The warning surfaced again in a case report published in 2020, also authored by CDC researchers and published in the journal Emerging Infectious Diseases. The report documented a puzzling 2018 case of melioidosis in a 63-year-old man from Atascosa County, Texas, in the Gulf Coast region. The man had no relevant travel history, reporting only a trip to Mexico taken 30 years before his illness.
