What Do A Raccoon, Aquarium, And Walmart’s Aromatherapy Spray Have In Common?

An unusual bacteria has been in the news, spotted at several different sites around the country this past year.

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

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

Burkholderia pseudomallei is a bacteria of particular concern as it could be used for bioterrorism. While the bacteria is found naturally in soil and water in Southeast Asia, introducing it suddenly here might cause many people to become ill with a difficult-to- diagnose infection. B. pseudomallei is also resistant to many commonly used antibiotics and requires more prolonged courses of more toxic antibiotics.

The CDC also recently reported that it had discovered B. pseudomallei in the body of a pet raccoon that was related to an outbreak last year. In that outbreak, in which the CDC showed remarkable sleuthing, four cases of infection were found in patients with no international travel—one each in Georgia, Kansas, Minnesota, and Texas. Two of the cases were fatal. The source of the melioidosis outbreak of was found to be “Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones.” The CDC found ontaminated spray in the home of the Georgia patient, a 5-year-old who died of disseminated melioidosis, with infection in his lungs, liver, and brain, as well as SARS-CoV-2 on autopsy.

The other infected child was from Texas. The CDC learned that the family’s pet raccoon had broken a bottle of the aromatherapy spray and walked through the liquid. About two weeks later, the raccoon developed neurological symptoms, died soon thereafter, and was buried. The CDC exhumed the pet’s body and found that two samples showed B. pseudomallei by PCR. Cultures from the pet and surrounding soil and water did not grow the bacterium.

The contaminated spray was subsequently recalled, and no other cases have been reported in the US from this event.

Last year, a Maryland woman also came down with melioidosis. She acquired the infection from her freshwater home aquarium. Almost all of the US guppies and plants for aquariums are provided by two retailers and come from SE Asia. A positive PCR for B pseudomallei was found in a water sample from imported fish in Los Angeles.

On the other hand, this past summer, B. pseudomallei was first discovered in soil and water in Mississippi. Sampling was prompted because two people living in close proximity on the Gulf Coast developed melioidosis—although the cases were two years apart. Previously, the bacterium was found primarily in SE Asia.

While melioidosis is endemic in SE Asia, there was a recent epidemic in Hong Kong, with 46 cases thus far. Because infections are more common after storms or typhoons, it is hypothesized that climate change might worsen outbreaks.

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

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

While Burkholderia are yet to be a major problem in the US, they may become so. Lab tests commonly misidentify the organisms. They are multi-drug resistant and difficult to treat. And with more violent tornadoes and hurricanes striking the Gulf Coast, we might expect to see more infections as the high winds could pick up and disperse contaminated soil..