Multistate outbreak of melioidosis associated with imported aromatherapy spray

Abstract

Journal of Paediatrics and Child HealthVolume 58, Issue 5 p. 933-934 Heads UpFree Access Multistate outbreak of melioidosis associated with imported aromatherapy spray First published: 26 March 2022 https://doi.org/10.1111/jpc.15956 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In 2021, a cluster of four cases of acute melioidosis were reported in patients from Kansas, Texas, Minnesota and Georgia, with no history of travel to endemic areas.1 Two of the four patients, including a 5-year-old boy, died; the surviving patients have significant morbidity related to their illness. The isolates from each patient were noted to be clonal. After extensive investigation of potential exposure items, Burkholderia pseudomallei was isolated from Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones from the house of patient 4, an aromatherapy sold across 55 Walmart stores within the United States. Whole-genome sequencing indicated the isolate from the spray bottle was the same strain found in all four patients. This strain (named aromatherapy spray 2021, ATS2021) clustered with samples of Burkholderia pseudomallei from South Asia that are consistent with the origins of the spray (Fig. 1). These cases highlight the potential risk of melioidosis due to imported products from regions where B. pseudomallei is endemic and the importance of astute clinical suspicion when patients do not respond to first-line empiric antibiotic regimens. The CDC has urged consumers to return the aromatherapy bottles to prevent the potential for B. pseudomallei to become established in the United States.2 Fig. 1Open in figure viewerPowerPoint Phylogenomic Comparisons of B. pseudomallei Genomes with Isolates Obtained from the Four Patients and from a Contaminated Aromatherapy Spray Bottle. (a) Core genome phylogeny= the core single-nucleotide polymorphism phylogeny of 1696 genomes in which the new isolates were initially placed. Geographic origins were selected from the BioSample database of the National Center for Biotechnology Information, and the specific geographic regions listed were based on definitions from the 2021 World Factbook of the Central Intelligence Agency (https://www.cia.gov/the-world-factbook/. opens in new tab). Samples of unknown geographic origin are white. The red branch inside the dashed red square denotes the outbreak strains, surrounded by isolates predominantly from South Asia. (b) Maximum-likelihood phylogenetic tree= the high-resolution clade with the closest isolates to the outbreak strain from maximum-likelihood analysis in Parsnp (Harvest, version 1.3) rendered with the use of MEGA X software (https://www.megasoftware.net/. opens in new tab). ATS2021 = aromatherapy spray 2021; GA2021a = patient 4, Georgia; MN2021a = patient 3, Minnesota; GA2021_Spray_1A = aromatherapy spray from house of patient 4; TX2021a = patient 2, Texas; KS2021a = patient 1, Kansas. References 1Gee JE, Bower WA, Kunkel A et al. Multistate outbreak of Melioidosis associated with imported aromatherapy spray. NEJM 2022; 386: 861– 8. 2 US Centers for Disease Control and Prevention. 2021. CDC lab testing confirms cause of melioidosis outbreak. Available from: https://www.cdc.gov/media/releases/2021/p1026-melioidosis-outbreak.html [accessed 6 March 2022]. Reviewers: Robert C Duguid, robert.duguid@health.nsw.gov.au, Sydney Children's Hospital, Sydney, NSW, Australia; Phoebe CM Williams, phoebe.williams1@health.nsw.gov.au, Sydney Children's Hospital, Sydney, NSW, Australia Volume58, Issue5May 2022Pages 933-934 FiguresReferencesRelatedInformation