Mysterious Cases of Illness With an
Unusual Cause

Christoph Renninger (Coliquio)

August 08, 2022

In 2021, in US states far removed from one another, numerous cases of melioidosis (Whitmore's disease) sprung up, some with a fatal outcome. What is the common factor linking all of those affected? So begins the search for evidence.

No Relations or Common Journeys

Between March and July 2021, cases of the bacterial infectious disease sprung up in Georgia, Kansas, Minnesota, and Texas, with the disease being fatal for two of those affected. Usually, cases of melioidosis occur in the United States after traveling to regions where the pathogen is prevalent. However, none of the patients had undertaken any previous international travel.

When the genomes of the bacterial strains (Burkholderia pseudomallei) were sequenced, they showed a high level of concordance, suggesting a common source of infection. The bacterial strain is similar to those that are found in Southeast Asia above all. An imported product from there was taken into consideration as the trigger.

The Centers for Disease Control and Prevention (CDC) examined blood samples from the patients, as well as samples from the soil, water, food, and household items around their homes.

Aroma Spray as a Trigger

In October, the cause of the melioidosis was finally identified in the house of the patient from Georgia: an aromatherapy spray. The genetic fingerprint of the bacterial strain matched with that from the other patients. The common trigger was thus discovered.

The contaminated spray, with a lavender-chamomile scent for room fragrancing, was sold between February and October in some branches of Walmart, as well as in their online store. The product was therefore recalled and it was checked whether the ingredients were also being used in other products.

The CDC requested physicians to also take melioidosis into account if they were presented with acute bacterial infections that did not respond to normal antibiotics and to inquire whether the affected room spray had been used.

More Information About Melioidosis

Melioidosis is an infectious disease affecting humans and animals. The trigger is the bacteria B pseudomallei. The disease appears predominantly in tropical regions, especially in Southeast Asia and northern Australia.

Transmission

The bacteria can be found in contaminated water and soil. It is disseminated between humans and animals through direct contact with the infectious source, such as through inhaling dust particles or water droplets, or through consuming contaminated water or food. Human-to-human transmission is extremely rare. Recently however, tropical saltwater fish were identified as potential carriers.

Symptoms

Melioidosis has a wide range of symptoms, which can lead to it being confused with other diseases such as tuberculosis or other forms of pneumonia. There are different forms of the disease, each with different symptoms.

Localized infection

  • Localized pain and swelling

  • Fever

  • Ulceration

  • Abscess

Pulmonary infection

  • Cough

  • Chest pain

  • High fever

  • Headaches

  • Loss of appetite

Bacteremia

  • Fever

  • Headaches

  • Breathing problems

  • Stomach discomfort

  • Joint pain

  • Disorientation

Disseminated infection

  • Fever

  • Weight loss

  • Stomach or chest pain

  • Muscle or joint pain

  • Headaches

  • Central nervous system infections

  • Epileptic seizures

The incubation time is not clearly defined and can be from 1 day to several years; however, the symptoms mostly emerge 2-4 weeks after exposure. The risk factors include diabetes, high alcohol consumption, chronic pulmonary or kidney disease, and immunodeficiencies.

Diagnosis based on the symptoms is often difficult since the clinical picture is similar to other, more common conditions.

Therapy

If the melioidosis is identified as such, it can be treated with only mildly effective antibiotics, since it has a natural resistance to many commonly used antibiotics. The type of infection and the course of treatment also affects the long-term outcome. Without treatment, 90% of the infections have a fatal outcome. With appropriate treatment, the mortality rate still lies at 40%.

Therapy generally begins with intravenous antibiotic therapy for at least 2-8 weeks (ceftazidime or meropenem). Oral antibiotic therapy then follows for 3-6 months (trimethoprim-sulfamethoxazole or amoxicillin/clavulanic acid). If the patient is allergic to penicillin, alternative antibiotics can be used.

Use as a Bioweapon

The CDC classifies B pseudomallei as a potential pathogen for biological attack (class-B candidate). They list the potential reasons for use as a bioweapon as:

  • The pathogen can be found naturally in certain regions.

  • The triggered disease can take a serious course and ultimately be fatal without appropriate therapy.

  • In the past, the US has used similar pathogens in wars as bioweapons.

In a potential attack, the pathogen could be spread through air, water, or food, and by doing so, many people would be exposed. Any contact with the bacteria can result in melioidosis. As the bacteria cannot be seen, smelled, or tasted, the biological attack would not be recognized for some time. A certain amount of time can also pass until the pathogen is identified, once fever and respiratory diseases have developed.

In such an emergency, the CDC would collaborate with other federal and local authorities to supply specialized testing laboratories and provide the public with information.

This content was translated from Coliquio.

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