After months of searching, CDC and state epidemiologists have discovered the source of a multi-state outbreak of >Burkholderia pseudomallei, which causes melioidosis, to be “Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones.”
Melioidosis is usually a tropical infection that can cause pneumonia, abscesses, or bloodstream infections and is generally acquired from contaminated soil or water. Thus, it was surprising to find four cases in the US this year in patients with no international travel. The cases occurred in Georgia, Kansas, Minnesota, and Texas and two patients died, including a 2-year old. Whole genome sequencing showed that the strains were closely related to those found in South Asia. That led the CDC to one hypothesis that the source of infection was an imported product.
To identify this, as with other outbreaks, the CDC does extensive interviews with patients, looking for any common exposures. They also took samples from soil, water, and consumer products in and around the patients’ homes, in addition to blood samples from the victims. Burkholderia pseudomallei showed up in the aromatherapy bottle from the Georgia patient’s home. It’s not yet known if the other patients used this or a similar product.
The CDC notes that the contaminated spray was “sold in 55 Walmart stores and on Walmart’s website between February and October 21. Five other scents in this product line were also sold and are included in the recall.” However, it is not yet known whether they were also contaminated. The spray was made in India.
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“Stop using this product immediately. Do not open the bottle. Do not throw away or dispose of the bottle in the regular trash.
Double bag the bottle in clean, clear zip-top bags and place in a small cardboard box. Return the bagged and boxed product to a Walmart store.
Wash sheets or linens that the product may have been sprayed on using normal laundry detergent and dry completely in a hot dryer; bleach can be used if desired.
Wipe down counters and surfaces that might have the spray on them with undiluted Pine-Sol or similar disinfectant.
Limit how much you handle the spray bottle and wash hands thoroughly after touching the bottle or linens. If you used gloves, wash hands afterward.”
One of the added problems in identifying melioidosis is that the symptoms may not occur for several weeks after exposure and can cause non-specific symptoms initially that could be readily overlooked.
Prolonged therapy with intravenous antibiotics are needed for melioidosis, followed by 3-6 months of trimethoprim-sulfamethoxazole (Bactrim).
Interestingly, there was also a recent outbreak of a related bacteria, Burkholderia cepacia, which I wrote about in em data-ga-track="ExternalLink:https://www.medscape.com/viewarticle/956548"">>Medscape. This outbreak was associated with contaminated ultrasound gel. The gel was used during placement of catheters for removal of fluid from the abdominal cavity and for invasive intravenous catheters. A member of the Burkholderia cepacia complex (Bcc), was found in a MediChoice® ultrasound gel and Eco-Med Pharmaceutical then recalled a number of lots of the gel.
One problem for hospital labs is that automated systems like Vitek have trouble identifying the organism. Rodney Rohde, PhD, MS, professor & chair, Clinical Lab Science Program at Texas State University said, “Automated clinical microbiology works very well for the typical “middle of the road” pathogens. These organisms often have a unique, fastidious nature about them with respect to culture AND differentiation. We often need to utilize manual methods to assist with confirmation.”
The difficulty of automated microbiology machines in identifying organisms reliably is a major problem as almost 40% of contamination reports in both sterile and non-sterile pharmaceutical products were caused by Bcc bacteria.
Along with Covid and all the recent food-borne outbreaks, these outbreaks highlight the need for a strong CDC and public health departments. They have been decimated by budget cuts. Last year, Kaiser Health News and the AP reported that “spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%” in the past decade. Additionally, “at least 38,000 state and local public health jobs have disappeared since the 2008 recession.”
Add to that the recent threats to public health officials, and we are facing a growing threat to our safety. According to the AP and KHN, “At least 181 state and local public health leaders in 38 states have resigned, retired or been fired since April 1.” They add that 40 million people—1 in 8—have lost their local health department leader during the pandemic. It’s not so much the work burden that is driving people away. It is that 24 states have drafted bills that limit public health authority. Furthermore, the harassment and threats to their very safety from the far-right extremists are forcing others to reconsider their calling.
As we read about the successes of the CDC and state epidemiologists—most recently with the melioidosis traced to India and the em data-ga-track="ExternalLink:https://www.cdc.gov/salmonella/oranienburg-09-21/index.html"">>Salmonella outbreak traced to onions from Mexico—we should also ask what we will do when the next outbreaks come and there are fewer people with experience to protect us.
Source : https://www.forbes.com/sites/judystone/2021/10/24/cdc-sleuths-find-source-of-deadly-melioidosis-outbreak-is-a-room-spray-sold-at-walmart/1473