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Mysterious cases of illness with an unusual cause
So begins the search for evidence.
No relations or common journeys
Between March and July 2021, cases of the bacterial infectious disease sprang 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 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 its 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, and abscess.
- Pulmonary infection: cough, chest pain, high fever, headaches, and loss of appetite
- Bacteremia: fever, headaches, breathing problems, stomach discomfort, joint pain, and disorientation.
- Disseminated infection: fever, weight loss, stomach or chest pain, muscle or joint pain, headaches, central nervous system infections, and 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). The agency lists 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 United States 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. A version appeared on Medscape.com.
So begins the search for evidence.
No relations or common journeys
Between March and July 2021, cases of the bacterial infectious disease sprang 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 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 its 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, and abscess.
- Pulmonary infection: cough, chest pain, high fever, headaches, and loss of appetite
- Bacteremia: fever, headaches, breathing problems, stomach discomfort, joint pain, and disorientation.
- Disseminated infection: fever, weight loss, stomach or chest pain, muscle or joint pain, headaches, central nervous system infections, and 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). The agency lists 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 United States 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. A version appeared on Medscape.com.
So begins the search for evidence.
No relations or common journeys
Between March and July 2021, cases of the bacterial infectious disease sprang 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 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 its 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, and abscess.
- Pulmonary infection: cough, chest pain, high fever, headaches, and loss of appetite
- Bacteremia: fever, headaches, breathing problems, stomach discomfort, joint pain, and disorientation.
- Disseminated infection: fever, weight loss, stomach or chest pain, muscle or joint pain, headaches, central nervous system infections, and 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). The agency lists 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 United States 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. A version appeared on Medscape.com.
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All rights reserved. This material may not be published, broadcast, copied, or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications Inc.</copyrightNotice> </rightsInfo> </provider> <abstract/> <metaDescription>In 2021, in U.S. states far removed from one another, numerous cases of melioidosis (Whitmore’s disease) sprang up, some with a fatal outcome. What is the commo</metaDescription> <articlePDF/> <teaserImage/> <teaser>Diagnosis based on the symptoms is often difficult since the clinical picture is similar to other, more common conditions.</teaser> <title>Mysterious cases of illness with an unusual cause</title> <deck/> <disclaimer/> <AuthorList/> <articleURL/> <doi/> <pubMedID/> <publishXMLStatus/> <publishXMLVersion>1</publishXMLVersion> <useEISSN>0</useEISSN> <urgency/> <pubPubdateYear/> <pubPubdateMonth/> <pubPubdateDay/> <pubVolume/> <pubNumber/> <wireChannels/> <primaryCMSID/> <CMSIDs/> <keywords/> <seeAlsos/> <publications_g> <publicationData> <publicationCode>idprac</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>chph</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>fp</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>im</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>mdemed</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> <journalTitle/> <journalFullTitle/> <copyrightStatement/> </publicationData> </publications_g> <publications> <term canonical="true">20</term> <term>6</term> <term>15</term> <term>21</term> <term>58877</term> </publications> <sections> <term canonical="true">39313</term> </sections> <topics> <term>316</term> <term canonical="true">317</term> <term>50347</term> <term>284</term> </topics> <links/> </header> <itemSet> <newsItem> <itemMeta> <itemRole>Main</itemRole> <itemClass>text</itemClass> <title>Mysterious cases of illness with an unusual cause</title> <deck/> </itemMeta> <itemContent> <p><span class="tag metaDescription">In 2021, in U.S. states far removed from one another, numerous cases of <a href="https://emedicine.medscape.com/article/830235-overview">melioidosis</a> (Whitmore’s disease) sprang up, some with a fatal outcome. What is the common factor linking all of those affected? </span>So begins the search for evidence.</p> <h2>No relations or common journeys </h2> <p>Between March and July 2021, cases of the bacterial infectious disease sprang 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.</p> <p>When the genomes of the bacterial strains (<em>Burkholderia pseudomallei</em>) 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.<br/><br/>The Centers for Disease Control and Prevention examined blood samples from the patients, as well as samples from the soil, water, food, and household items around their homes.<br/><br/></p> <h2>Aroma spray as a trigger </h2> <p>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.</p> <p>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.<br/><br/>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.<br/><br/></p> <h2>More information about melioidosis </h2> <p>Melioidosis is an infectious disease affecting humans and animals. The trigger is the bacteria<em> B pseudomallei</em>. The disease appears predominantly in tropical regions, especially in Southeast Asia and northern Australia.</p> <h2>Transmission </h2> <p>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.</p> <h2>Symptoms </h2> <p>Melioidosis has a wide range of symptoms, which can lead to its being confused with other diseases such as tuberculosis or other forms of pneumonia. There are different forms of the disease, each with different symptoms.</p> <ul class="body"> <li>Localized infection: localized pain and swelling, fever, ulceration, and abscess.</li> <li>Pulmonary infection: cough, chest pain, high fever, headaches, and loss of appetite</li> <li>Bacteremia: fever, headaches, breathing problems, stomach discomfort, joint pain, and disorientation.</li> <li>Disseminated infection: fever, weight loss, stomach or chest pain, muscle or joint pain, headaches, central nervous system infections, and epileptic seizures.</li> </ul> <p>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.<br/><br/>Diagnosis based on the symptoms is often difficult since the clinical picture is similar to other, more common conditions.<br/><br/></p> <h2>Therapy </h2> <p>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%.</p> <p>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.<br/><br/></p> <h2>Use as a bioweapon </h2> <p>The CDC classifies <em>B pseudomallei </em>as a potential pathogen for biological attack (class-B candidate). The agency lists the potential reasons for use as a <a href="https://emedicine.medscape.com/article/829613-overview">bioweapon</a> as:</p> <ul class="body"> <li>The pathogen can be found naturally in certain regions.</li> <li>The triggered disease can take a serious course and ultimately be fatal without appropriate therapy.</li> <li>In the past, the United States has used similar pathogens in wars as bioweapons.</li> </ul> <p>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.<br/><br/>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.</p> <p> <em>This content was translated from <a href="https://www.coliquio.de/wissen/Patientenfall-Kasuistik-100/melioidiose-raetselhafte-faelle-usa">Coliquio.</a> A version appeared on <span class="Hyperlink"><a href="https://www.medscape.com/viewarticle/978807">Medscape.com</a></span>.</em> </p> </itemContent> </newsItem> <newsItem> <itemMeta> <itemRole>teaser</itemRole> <itemClass>text</itemClass> <title/> <deck/> </itemMeta> <itemContent> </itemContent> </newsItem> </itemSet></root>