The fourth person affected by a bacterial outbreak related to imported aromatherapy room sprays sold at Walmart last year occurred with a previously healthy 5-year-old boy in Georgia, who died of the infection. That’s according to new information presented Tuesday at the International Conference on Emerging Infectious Diseases (ICEID), hosted by the Centers for Disease Control and Prevention in Atlanta.
The tragic new details of the boy’s cases – presented by epidemiologist Jessica Pavlick of the Georgia Department of Public Health – have new meaning for the US. In the year after the boy’s death, the tropical soil bacteria behind his deadly infection has been found in environmental samples in southern Mississippi. The bacteria—Burkholderia pseudomallei– is now considered endemic to the Gulf Coast region and poses an ever-present threat to the people of the area.
Tragic infection
For years, CDC researchers have suspected that: B. pseudomallei could already be lurking in the soil and water in the continental US, rather than being brought in through imported animals and products (like the room sprays), as well as travelers and migrants. In recent years, the US has averaged about 12 cases of B. pseudomallei infection, which causes a disease called melioidosis.
Most cases are related to travel, but not all, leading CDC researchers to speculate that B. pseudomallei had become a permanent resident rather than an occasional intruder. It wasn’t until an unexplained case in southern Mississippi in 2022 — which occurred just miles away from another mysterious case from 2020 — that investigators finally caught on. B. pseudomallei in US environmental samples.
Although cases of melioidosis are rare, even in places where B. pseudomallei is most common – namely in Southeast Asia and Northern Australia – when they occur, they can be difficult to diagnose and treat, and it can easily become fatal. Awareness of the disease and prompt diagnosis are critical. Unfortunately, this was not the case for the 5 year old in Georgia.
The boy became ill in July 2021. At that time, the CDC already issued a nationwide warning on June 30 about three other cases of melioidosis in three other states: Kansas, Minnesota and Texas. Despite the scattered cases, genetic analyzes of the B. pseudomallei isolates indicated that they were all linked together and that the strain could be traced back to those found in India and Sri Lanka.
The first case occurred in March 2021 in an adult in Kansas who died of the infection. The other two cases occurred in May: an adult in Minnesota who survived and a 4-year-old girl in Texas who suffered brain damage. Although state and CDC health researchers knew the cases were linked and that an imported product or animal was likely to blame, they have yet to find a common source. According to Pavlick’s presentation Tuesday, the tragic deaths of the boys in Georgia would reveal the answer.
Pavlick explained the boy’s case and its aftermath. On July 7, a week after the CDC’s melioidosis warning, the boy began to feel ill with fever, weakness, sore throat, nausea and vomiting. Pavlick noted that he had no underlying health problems and was previously considered healthy. On July 12, the boy was taken to a local emergency department and hospitalized, where he tested positive for SARS-CoV-2, which may have obscured his melioidosis. The next day, he was transferred to a children’s hospital out of concern for respiratory failure. There he was admitted to the pediatric intensive care unit. The next day, July 14, he was intubated. He grew weaker and rapidly deteriorated and died on July 16.
To test
A week later, post-mortem tests performed by the hospital lab indicated for the first time: B. pseudomallei infection. The bacterium was found in the boy’s brain, lungs, liver and spleen. The state health department labeled it a suspected case on July 26, and the CDC confirmed melioidosis and its link to the other three cases on July 29, Pavlick said.
As Ars previously reported, melioidosis has been described as the “great mimic” because its symptoms can be distinct, vague, and similar to other serious conditions, such as tuberculosis. The bacteria can cause infection through several routes, allowing for a broad presentation. People can become infected if they ingest soil, water, or food that contains the bacteria; if they inhale contaminated dust or water droplets; or if soil or water containing the germ comes into contact with a break in the skin.
b. pseudomallei is also resistant to many common antibiotics, and delayed treatment can cause the bacteria to spread further in the body, leading to a deadly disseminated infection, such as that seen in the fry.
After the boy’s death, his family allowed state and CDC researchers to test relatives, environmental samples and household products to find out how the boy picked up the deadly bacteria. Tests showed that two of the four family members had antibodies against: B. pseudomallei, indicating past exposure. On Aug. 10, researchers collected 55 samples of household products and 38 samples from the area surrounding the family’s large, rural property. All tested negative for B. pseudomallei. On October 6, the family agreed to have the researchers return, after which the researchers tested nine more environmental samples and 14 more household products.
One of those second round products was a Better Homes & Gardens lavender and chamomile essential oil infused aromatherapy room spray with gemstones, which was made in India and tested positive for B. pseudomallei. On October 26, the CDC confirmed the finding, announcing that the spray was the source of the bacterial strain in all four cases of melioidosis.
