The fourth person affected by a bacterial outbreak linked to imported aromatherapy room sprays sold at Walmart last year occurred in 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 newfound significance for the US. In the year since the boy's death, the tropical soil bacterium behind his deadly infection has been found in environmental samples in southern Mississippi. The bacterium—Burkholderia pseudomallei—is now considered endemic to the Gulf Coast region, creating an ever-present threat to people in the area.
For years, CDC researchers have suspected that B. pseudomallei could already be lurking in soil and water in the continental US, rather than being brought in via 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 of the cases are linked to travel, but not all of them, leading CDC researchers to speculate that B. pseudomallei had become a permanent resident rather than an occasional interloper. 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 B. pseudomallei in US environmental samples.
Though melioidosis cases are rare even in places where B. pseudomallei is most prevalent—namely in Southeast Asia and northern Australia—when they occur, they can be difficult to diagnose and treat, and it can easily turn deadly. Awareness of the disease and rapid diagnosis are critical. This was sadly not the case for the 5-year-old in Georgia.
The boy fell ill in July 2021. At that point, the CDC has already issued a nationwide alert on June 30 over three other melioidosis cases in three other states: Kansas, Minnesota, and Texas. Despite the scattered cases, genetic analyses of the B. pseudomallei isolates indicated that they were all connected and that the strain 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 two other cases occurred in May: an adult in Minnesota who survived and a 4-year-old girl in Texas who was left with brain damage. Though state and CDC health investigators knew the cases were connected and that an imported product or animal was likely to blame, they had yet to figure out a common source. According to Pavlick's presentation Tuesday, the boys' tragic death in Georgia would reveal the answer.
Pavlick laid out the boy's case and the aftermath. On July 7, a week after the CDC's melioidosis alert, the boy started feeling ill with fever, weakness, sore throat, nausea, and vomiting. Pavlick noted that he had no underlying health conditions and was previously considered healthy. By July 12, the boy was taken to a local emergency department and admitted to the hospital, 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 became weaker and, on July 16, rapidly deteriorated and died.
A week later, post-mortem testing conducted by the hospital laboratory first indicated a B. pseudomallei infection. The bacterium was found in the boy's brain, lung, liver, and spleen. The state health department designated it a presumptive case on July 26, and the CDC confirmed melioidosis and its link to the other three cases on July 29, Pavlick said.
As Ars has reported previously, melioidosis has been described as the “great mimicker” because its symptoms can be various, vague, and similar to other serious conditions, such as tuberculosis. The bacteria can establish an infection through various routes, allowing for wide-ranging presentations. People can be infected if they ingest soil, water, or food that contains the bacteria; if they breathe in contaminated dust or water droplets; or if soil or water harboring the germ comes in contact with a break in the skin.
B. pseudomallei is also resistant to many common antibiotics, and delayed treatment can allow the bacteria to spread further in the body, leading to a deadly disseminated infection, like the one seen in the boy.
After the boy's death, his family allowed state and CDC investigators to test family members, environmental samples, and household products to try to figure out how the boy had picked up the deadly bacteria. Testing found that two of four family members had antibodies against B. pseudomallei, suggesting past exposure. On August 10, investigators collected 55 household product samples and 38 environmental samples from around the family's large, rural property. All tested negative for B. pseudomallei. On October 6, the family agreed to let the investigators come back, at which point the investigators tested nine more environmental samples and 14 more household products.
One of those second-round products was a Better Homes & Gardens Lavender & 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 and announced that the spray was the source of the bacterial strain in all four melioidosis cases.