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Burkholderia pseudomallei is a gram negative saprophytic (feeds on dead or decaying organic matter) bacterium that is often found in soil and water in endemic regions. This is a particularly nasty pathogen - enough so that is is considered to have at least some bioterrorism applications.
From the CDC website.
Bioterrorism
Melioidosis is a disease caused by germs that occur naturally in certain parts of the world, such as Southeast Asia and northern Australia. The only places these germs, called Burkholderia pseudomallei, occur naturally in the United States is Puerto Rico and U.S. Virgin Islands. One reason public health authorities study the disease is because it is possible that the germs that cause melioidosis might be used in a biological attack. A biological attack is the intentional release of germs that can sicken or kill people, livestock, or crops.
While cases in the United States are exceedingly rare, about a dozen (usually imported) human infections are reported each year.
There are exceptions, however, as we saw a little over two years ago in an EID Journal dispatch called Melioidosis in a Resident of Texas with No Recent Travel History, United States.
Over the past two decades researchers from the CDC and Texas have identified at least 4 cases in the Southwestern United States with unknown exposures, prompting them to write:
Isolates TX2004 and TX2018b were collected ≈15 years apart from patients living in the same Texas county at time of illness onset and group together, a finding that suggests B. pseudomallei might be present in the environment in this area. Furthermore, these 2 isolates might represent a new clade endemic to the continental United States. Further investigation is warranted because this region is predicted to have suitable habitats for B. pseudomallei (14).
Last year (2021) we saw an unusual multi-state (Georgia, Kansas, Minnesota, & Texas) outbreak of Melioidosis, involving 4 patients - both adults and children - 2 of whom died. The CDC launched an investigation, publishing two CDC HAN advisories over the summer (see below).
CDC HAN Update: 4th Case of Non-Travel Related Melioidosis Reported - Georgia
CDC HAN: Multi-state Investigation of Non-travel Associated Melioidosis in Three Patients: Kansas, Texas, and Minnesota—2021
After months of investigation, a year ago the CDC announced a promising break in the investigation (see CDC Update On Multi-State Outbreak Of Melioidosis), after B. pseudomallei was detected in a bottle of imported aromatherapy spray found in the home of the 4th victim (from Georgia).
A recall was announced, as investigators continued to try to link the three other cases to the imported aromatherapy product.
Also in December of last year the CDC's EID Journal published details on yet another unusual domestic case from 2019 (see Human Melioidosis Caused by Novel Transmission of Burkholderia pseudomallei from Freshwater Home Aquarium, United States) which appears to be linked to imported tropical fish.
The plot thickened once again last July, when the CDC issued a HAN Advisory (LINK) confirming - for the first time - detection of environmental B. pseudomallei in the continental United States after two residents of Mississippi were found to be infected with the same novel strain (in 2020, and 2022).
An accompanying press release from the CDC stated:
Bacteria that Causes Rare Disease Melioidosis Discovered in U.S. Environmental Samples
Press Release
(Excerpt)
Melioidosis has a wide range of nonspecific symptoms like fever, joint pain, and headaches and can cause conditions that include pneumonia, abscess formation, or blood infections. Worldwide, melioidosis is fatal in 10 – 50% of those infected. B. pseudomallei has historically been found in tropical and sub-tropical areas such as South and Southeast Asia, northern Australia, and parts of Central and South America and Puerto Rico. Given the very small number of cases of melioidosis identified historically in the United States, CDC believes the risk of melioidosis for the general population continues to be very low.Individuals living in the Gulf Coast of Mississippi and who have health conditions that may put them at higher risk—such as diabetes, chronic kidney disease, chronic lung disease, or excessive alcohol use— should take precautions to protect themselves:
- Avoid contact with soil or muddy water, particularly after heavy rains, and protect open wounds with waterproof dressings.
- Wear waterproof boots when gardening, doing yard work, or doing agricultural work, which can prevent infection through the feet and lower legs—particularly after flooding or storms.
- Wear gloves to protect the hands when working directly with soil.
CDC encourages healthcare providers in the Gulf Coast region of the southern United States as well as clinicians throughout the country to learn about melioidosis and to be aware of the potential for more cases as CDC and partners continue to investigate the geographic spread of B. pseudomallei. As a nationally notifiable disease, melioidosis should always be reported to the state health department.
For more information, visit CDC’s melioidosis website.
Next week (Thursday, Oct 13th) the CDC will hold a COCA call for clinicians on what they need to know in order to prevent, diagnose, and treat melioidosis. These 1-hour presentations are often technical in nature, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to others.
Details on attending this webinar follow, but as always, if you are unable to attend the live presentation, these (and past) videos are always archived and available for later viewing at this LINK.
Melioidosis in the United States: What Clinicians Need to Know Following Newly Discovered Endemicity
Overview
The causative bacteria Burkholderia pseudomallei (B. pseudomallei) was recently found in soil and water in the southern United States. This bacterium causes a rare and serious disease called melioidosis. During this COCA Call, presenters will provide updates on the new and evolving epidemiology of melioidosis in the United States and discuss what clinicians need to know to prevent, diagnose, and treat melioidosis. They will also address what the Centers for Disease Control and Prevention (CDC) is doing to learn more about melioidosis in the United States.
Presenters
Julia Petras, MSPH, BSN, RN
Epidemic Intelligence Service Officer
Bacterial Special Pathogens Branch
Division of High-Consequence Pathogens & Pathology
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Caroline A. Schrodt, MD, MSPH
Lieutenant Commander, U.S. Public Health Service
Bacterial Special Pathogens Branch
Division of High-Consequence Pathogens & Pathology
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Mindy Elrod, BS
Microbiologist
Zoonoses and Select Agent Laboratory
Bacterial Special Pathogens Branch
Division of High-Consequence Pathogens & Pathology
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Call Materials
Not available at this time. Please check back.
Call Details
When:
Thursday, October 13, 2022,
2:00 PM – 3:00 PM ET
Webinar Link:
https://www.zoomgov.com/j/1604758867
Webinar ID: 160 475 8867
Passcode: 254552
Telephone:
US: +1 669 254 5252 or +1 646 828 7666 or +1 669 216 1590 or +1 551 285 1373
International numbers
One-tap mobile:
US: +16692545252,,1604758867#,,,,*254552# or +16468287666,,1604758867#,,,,*254552#
