Abstract
Nearly all cases of melioidosis in the continental United States are related to international travel to areas to which Burkholderia pseudomallei, the bacterium that causes melioidosis, is endemic. We report the diagnosis and clinical course of melioidosis in a patient from the United States who had no international travel history and the public health investigation to determine the source of exposure. We tested environmental samples collected from the patient’s home for B. pseudomallei by PCR and culture. Whole-genome sequencing was conducted on PCR-positive environmental samples, and results were compared with sequences from the patient’s clinical specimen. Three PCR-positive environmental samples, all collected from a freshwater home aquarium that had contained imported tropical fish, were a genetic match to the clinical isolate from the patient. This finding suggests a novel route of exposure and a potential for importation of B. pseudomallei, a select agent, into the United States from disease-endemic areas.
Highlights
Most cases of melioidosis in the continental United States are related to international travel to areas to which Burkholderia pseudomallei, the bacterium that causes melioidosis, is endemic
She reported that she was the primary caretaker of the fish and recalled reaching bare hands and arms into the water and gravel of tank B to disrupt sediment while cleaning it, as recently as August 2019. This investigation of a patient who had melioidosis and no history of travel to disease-endemic areas provides strong evidence for documented transmission of B. pseudomallei from a freshwater home aquarium to a human. This type of transmission has not been described in the literature, contamination of aquarium transport water with B. pseudomallei used for freshwater tropical fish originating from Singapore has been reported in France [17]
Freshwater fishing practices have been identified as risk factors in countries to which melioidosis is endemic [7,18,19]
Summary
Most cases of melioidosis in the continental United States are related to international travel to areas to which Burkholderia pseudomallei, the bacterium that causes melioidosis, is endemic. Three PCR-positive environmental samples, all collected from a freshwater home aquarium that had contained imported tropical fish, were a genetic match to the clinical isolate from the patient. This finding suggests a novel route of exposure and a potential for importation of B. pseudomallei, a select agent, into the United States from disease-endemic areas. B. pseudomallei from Freshwater Home Aquarium most US cases are related to previous residence in or travel to disease-endemic areas outside the continental United States [15]. The patient had a history of polymyositis, rheumatoid arthritis, and diabetes mellitus, and reported to have stopped long-term immunosuppressive medications (methotrexate, azathioprine, and prednisone) 1 month before symptom onset
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