Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray

Jay E Gee; William A Bower; Amber Kunkel; Julia Petras; Jenna Gettings; Maria Bye; Melanie Firestone; Mindy G Elrod; Lindy Liu; David D Blaney; Allison Zaldivar; Chelsea Raybern; Farah S Ahmed; Heidi Honza; Shelley Stonecipher; Briana J O'Sullivan; Ruth Lynfield; Melissa Hunter; Skyler Brennan; Jessica Pavlick; Julie Gabel; Cherie Drenzek; Rachel Geller; Crystal Lee; Jana M Ritter; Sherif R Zaki; Christopher A Gulvik; W Wyatt Wilson; Elizabeth Beshearse; Bart J Currie; Jessica R Webb; Zachary P Weiner; María E Negrón; Alex R Hoffmaster

doi:10.1056/NEJMoa2116130

Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray

N Engl J Med. 2022 Mar 3;386(9):861-868. doi: 10.1056/NEJMoa2116130.

Authors

Jay E Gee¹, William A Bower¹, Amber Kunkel¹, Julia Petras¹, Jenna Gettings¹, Maria Bye¹, Melanie Firestone¹, Mindy G Elrod¹, Lindy Liu¹, David D Blaney¹, Allison Zaldivar¹, Chelsea Raybern¹, Farah S Ahmed¹, Heidi Honza¹, Shelley Stonecipher¹, Briana J O'Sullivan¹, Ruth Lynfield¹, Melissa Hunter¹, Skyler Brennan¹, Jessica Pavlick¹, Julie Gabel¹, Cherie Drenzek¹, Rachel Geller¹, Crystal Lee¹, Jana M Ritter¹, Sherif R Zaki¹, Christopher A Gulvik¹, W Wyatt Wilson¹, Elizabeth Beshearse¹, Bart J Currie¹, Jessica R Webb¹, Zachary P Weiner¹, María E Negrón¹, Alex R Hoffmaster¹

Affiliation

¹ From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia.

Abstract

Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an uncommon infection that is typically associated with exposure to soil and water in tropical and subtropical environments. It is rarely diagnosed in the continental United States. Patients with melioidosis in the United States commonly report travel to regions where melioidosis is endemic. We report a cluster of four non-travel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas. These cases were caused by the same strain of B. pseudomallei that was linked to an aromatherapy spray product imported from a melioidosis-endemic area.

Publication types

Case Reports

MeSH terms

Aerosols
Aromatherapy / adverse effects*
Brain / microbiology
Brain / pathology
Burkholderia pseudomallei / genetics
Burkholderia pseudomallei / isolation & purification*
COVID-19 / complications
Child, Preschool
Disease Outbreaks*
Fatal Outcome
Female
Genome, Bacterial
Humans
Lung / microbiology
Lung / pathology
Male
Melioidosis / complications
Melioidosis / epidemiology*
Middle Aged
Phylogeny
Shock, Septic / microbiology
United States / epidemiology

Substances

Aerosols

Grants and funding

CC999999/ImCDC/Intramural CDC HHS/United States