What do a raccoon, an aquarium and an aromatherapy spray from Walmart have in common?

An unusual bacterium has made headlines, spotted at several different sites across the country last year.

The Guardian reported last week that six cases of Burkholderia pseudomallei had been identified in primates imported from Cambodia to the United States between 2018 and 2021 and complained that the CDC had not been “transparent” about the cases. (The number of imported macaques has increased from 5,851 in 2018 to 18,870 in 2021. The number of sick and dying primates has also increased dramatically, with the number of sick increasing “by 2,280%, from five to 119 in 2021, and overall mortality has increased from 31 to 136 over five years.”

People for the Ethical Treatment of Animals (PETA) has asked the CDC to stop the importation of all non-human primates – a reasonable request not only because of unnecessary cruelty to animals, but because animals can harbor a variety of bacteria and viruses. If Covid has taught us anything, it should include being wary of importing virus from abroad.

Burkholderia pseudomallei is a bacterium of particular concern because it could be used for bioterrorism. While the bacteria is found naturally in soil and water in Southeast Asia, its sudden introduction here could sicken many people with a hard-to-diagnose infection. B pseudomallei is also resistant to many commonly used antibiotics and requires longer courses of more toxic antibiotics.

The CDC also recently reported that it had discovered B pseudomallei in the body of a pet raccoon linked to an outbreak last year. During this epidemic, during which the CDC demonstrated remarkable research, four cases of infection were discovered in patients who had not traveled abroad, one in Georgia, Kansas, Minnesota and in Texas. Two of the cases were fatal. The source of the melioidosis outbreak turned out to be “Better Homes & Gardens Lavender & Camomile Essential Oil Infused Aromatherapy Room Spray with Gemstones”. The CDC found a contaminated spray in the home of the Georgia patient, a 5-year-old child who died of disseminated melioidosis, with infection of the lungs, liver and brain, as well as SARS-CoV-2 at autopsy.

The other infected child was from Texas. The CDC has learned that the family’s raccoon broke an aromatherapy spray bottle and ran through the liquid. About two weeks later, the raccoon developed neurological symptoms, died shortly thereafter, and was buried. The CDC exhumed the animal’s body and discovered that two samples showed B pseudomallei by PCR. Cultures of the pet and surrounding soil and water did not grow the bacteria.

The contaminated spray was later recalled and no further cases have been reported in the United States as a result of this event.

Last year, a Maryland woman also contracted melioidosis. She contracted the infection in her freshwater aquarium. Almost all American guppies and aquarium plants are supplied by two retailers and come from Southeast Asia. A positive PCR for B pseudomallei Was found in a sample of fish water imported to Los Angeles.

On the other hand, last summer, B. pseudomallei was first discovered in the soil and water of the Mississippi. The sampling was triggered because two people living nearby on the Gulf Coast developed melioidosis, although the cases were separated by two years. Previously, the bacterium was mainly found in Southeast Asia.

While melioidosis is endemic in Southeast Asia, there has been a recent outbreak in Hong Kong, with 46 cases so far. Since infections are more common after storms or typhoons, it is hypothesized that climate change could make outbreaks worse.

A closely related species, B.cepacia, also cropped up more frequently. B cepacia commonly causes contamination of water-based products and is a problem for manufacturers of oral solutions and rinses, even for antiseptics such as povidone iodine, benzalkonium chloride, and chlorhexidine gluconate.

B.cepacia is particularly a problem for patients with cystic fibrosis and those who have had lung transplants, as I wrote in salt in my soul and here, for mycobacterial infections. Because B.cepacia is also resistant to many antibiotics, efforts are currently focused on treating these infections with bacteriophages, viruses that infect and kill bacteria.

While Burkholderia are not yet a major problem in the United States, they could become one. Laboratory tests often misidentify organisms. They are multiresistant and difficult to treat. And with stronger tornadoes and hurricanes hitting the Gulf Coast, we might expect to see more infections as high winds might pick up and disperse contaminated soil.

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