Expand / Burkholderia pseudomallei grown in sheep blood agar for 24 hours. B. pseudomallei is an aerobic Gram-negative bacterium and is the causative agent of melioidosis.
For years, US health officials observed sporadic and mysterious cases of a foreign bacterial infection, called melioidosis. The infection, which is difficult to diagnose, difficult to treat and often fatal, was thought to affect only travelers or those who came into contact with contaminated imported products or animals. However, every now and then an American would become inexplicably ill: no recent travel, no clear links.
Now, health officials have a definitive explanation. And it confirms a long-held and feared suspicion: the deadly bacterium is no longer uncommon. Rather, he is a permanent resident of the United States rooted in American soil.
Three samples taken from soil and pond water in the Gulf Coast region of southern Mississippi tested positive for the bacteria, officials from the Centers for Disease Control and Prevention announced Wednesday. The sampling was part of an investigation into two mysterious cases in the area that occurred in 2020 and 2022. The positive test results mark the first time researchers have captured the deadly germ in US environmental samples, all and that they have been looking for it for years.
It is not clear how long the bacteria has resided in the United States or how widespread its distribution is. But CDC modeling suggests that environmental conditions in the Gulf Coast states are favorable for the bacteria to grow. The agency has requested extensive environmental sampling.
While the finding explains the puzzling cases, the most important thing now is for health officials to spread the word. This is no longer traveler’s disease. In a health advisory issued yesterday, the CDC stressed that its advisory “serves to alert physicians and public health officials nationwide to consider melioidosis in patients whose clinical presentation is compatible with signs and symptoms of the disease, regardless of travel history to international disease. -endemic regions, as melioidosis is now considered to be locally endemic in areas of the Mississippi Gulf Coast region.”
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New resident
The bacteria in question is Burkholderia pseudomallei, which lives in the soil and water of tropical and subtropical regions and causes rare but dangerous sporadic infections. The most endemic areas are in Southeast Asia and northern Australia, but it has also appeared in areas of Southwest Asia, Africa, the Pacific and the Americas, such as Peru, Brazil, Haiti and some territories of the USA, including Puerto. rich
B. pseudomallei causes melioidosis through transmission in several ways, all involving direct contact with contaminated soil and water. People can become infected if they ingest contaminated soil, water or food; if they breathe in contaminated dust or water droplets; or if contaminated soil or water comes into contact with a break in the skin. People who are more at risk of melioidosis than others are those with specific conditions, such as diabetes, heavy alcohol use, chronic lung disease, chronic kidney disease, and conditions that weaken immune responses. The good news is that the infection is rarely spread from person to person.
The following symptoms of melioidosis may depend on the route B. pseudomallei takes in the body. If it enters through a skin wound, it could cause pain, swelling, and an abscess. If it enters the bloodstream, it can cause joint pain, abdominal discomfort and disorientation. If it enters the lung, it can cause coughing and chest pain. And if it becomes systemic, it can cause weight loss, a brain infection, and seizures. In general, symptoms can seem nebulous and can easily be confused with other conditions. It has been described as “the great imitator” because of how often and easily it is confused with other serious infections, such as tuberculosis.
Its indistinct nature contributes to its mortality. B. pseudomallei is naturally resistant to many commonly used antibiotics. Any delay in an accurate diagnosis can allow the bacteria to cause more serious illness. According to the CDC, melioidosis is fatal in 90 percent of people who do not receive proper treatment. When people are treated with the correct antibiotics, the death rate drops below 40%. And if patients have access to intensive care and the right drugs, the death rate drops to about 20 percent.
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For all these reasons, the US government considers B. pseudomallei a bioterrorism threat, classifying it as a Tier 1 select agent along with the anthrax bacteria (Bacillus cereus Biovar anthracis) and the Ebola virus .
US cases
According to the CDC, the US has an average of about 12 cases of melioidosis per year, most of which have been travel-related. But there have been notable and puzzling exceptions over the years.
Last year, melioidosis made headlines when four people in four states were infected with the same strain of B. pseudomallei. The first unexplained cases, which were fatal, occurred in an adult in Kansas in March. Then another adult in Minnesota survived and a 4-year-old boy in Texas was left with brain damage. Finally, a child in Georgia was identified as a case through a post-mortem examination.
In October, researchers announced a break in the baffling outbreak: The strain of B. pseudomallei causing the infections was found in an aromatherapy spray, made in India, that contained “precious stones.” Specifically, it was the Better Homes & Gardens Gemstone Aromatherapy Spray with Lavender and Chamomile Essential Oil, which Walmart sold.
Although the researchers suspected an imported product early on, the group drew attention to other puzzling cases in the United States, cases that had raised concerns that B. pseudomallei was lurking on American soil. In 2015, for example, CDC researchers surveyed all 34 cases of human melioidosis in the US between 2008 and 2013, and found that cases appeared to increase each year during that period. The study, published in the CDC’s Morbidity and Mortality Weekly Report, concluded that B. pseudomallei may be an emerging infectious disease in the US.
“Notably, three cases of melioidosis occurred in US residents with no history of travel outside the United States or to regions where melioidosis is endemic, possibly indicating unrecognized sources of exposure in the United States,” the researchers wrote. “Therefore, it is important to be aware that this infection can be seen in people with no obvious history of travel to places where B. pseudomallei is endemic.”
The warning note reappeared in a case report published in 2020, also written by CDC researchers and published in the journal Emerging Infectious Diseases. The report documented a puzzling 2018 case of melioidosis in a 63-year-old man from Atascosa County, Texas, which is located in the Gulf Coast region. The man had no relevant travel history, only reporting a trip to Mexico made 30 years before his illness.