Gerry Palmers Science 08.11.2022 03:Aug AM EDT

New Details Emerge on Georgia Boy Who Died From a Tropical Bacteria Linked to Aromatherapy Room Spray Sold at Walmart

New details have emerged on the death of a five-year-old child in Georgiawho died of a tropical bacteria linked to an aromatherapy room spray sold in Walmart in 2021.

Jessica Pavlick of the Georgia Department of Public Health said in a presentation Tuesday at the International Conference on Emerging Infectious Diseases (ICEID), hosted by the U.S.Centers for Disease Control and Prevention (CDC) in Atlanta, made the link of the boy's death to the now recalled aromatherapy room sprays.

In the year since the boy's death, the tropical soil bacterium behind his deadly infection has been found in environmental samples across southern Mississippi. The bacteriu, called Burkholderia pseudomallei, has been considered endemic to the Gulf Coast region, and considered a continuing threat to people living in the region.

Bacteria that Caused Boy's Death

For years, CDC researchers suspected that B. pseudomallei could already be lurking in soil and water in the continental US, rather than being brought in via imported animals and household products, as well as travelers and migrants. In recent years, the US has averaged about 12 cases of B. pseudomallei infection, which causes the melioidosis disease.

Most of the melioidosis cases have been linked to travel, making CDC researchers speculate that B. pseudomallei had become a permanent in the region and not an occasional visitor. It wasn't until an unexplained case in southern Mississippi in 2022-which occurred just miles away from another mysterious case from 2020-that investigators finally caught B. pseudomallei in US environmental samples.

Though melioidosis cases are quite rare, including in locations where B. pseudomallei is mostly prevalent, such as Southeast Asia and northern Australia. It is difficult to diagnose and treat, and can easily turn fatal. As such, awareness of the disease and rapid diagnosis are critical. Unfortunately, this was not the case for the 5-year-old in Georgia.

In her presentation, Pavlick said the boy fell ill in July 2021. At that time, the CDC has already issued a nationwide alert on over three other melioidosis cases in three other states: Kansas, Minnesota, and Texas. Even with the scattered cases, genetic analyses of the B. pseudomallei isolates indicated that they were all connected and that the strain were traced to those discovered in India and Sri Lanka.

How Melioidosis Killed 4 in US

The first melioidosis case happened in March 2021 in Kansas adult, who died of the infection. The two other cases occurred in May: a Minnesota adult who survived and a four-year-old girl in Texas who was stricken with brain damage. Though state and CDC health investigators knew the cases were connected and that an imported product or animal was likely to blame, they weren't able to determine a common source. According to Pavlick's presentation, the boys' tragic death revealed the answer.

Pavlick said that on July 7, a week after the CDC's melioidosis alert, the boy started feeling ill with fever, weakness, sore throat, nausea, and vomiting. She noted that the boy had no underlying health conditions and was previously considered healthy. By July 12, the boy was admitted to a local hospital, where he tested positive for SARS-CoV-2, which could have obscured his melioidosis. The next day, he was transferred to a children's hospital for possible respiratory failure and was admitted to the pediatric intensive care unit. He was intubated the next day. His condition worsene and, on July 16, the boy's condition rapidly deteriorated and died.

A week later, post-mortem testing conducted by the hospital laboratory first indicated a B. pseudomallei infection, which was found in the boy's brain, lung, liver, and spleen. The state health department designated it a presumptive case on July 26, and the CDC confirmed melioidosis and its link to the other three cases on July 29, Pavlick said.

Melioidosis has been considered as the "great mimicker" because its varied and vaague symptoms, which can be similar to other serious conditions, such as tuberculosis. The bacteria can establish an infection through different routes, allowing for wide-ranging presentations. Infections can happen when people ingest soil, water, or food that carries the bacteria, breathe in contaminated dust or water droplets, or if a break in the skin could come in contact with soil or water harboring the germ.

It is worth noting that B. pseudomallei is resistant to many common antibiotics, and delayed treatment can allow the bacteria to spread further in the body, leading to a deadly disseminated infection, like the one seen in the boy.

After the boy's death, his family allowed state and CDC investigators to test family members, environmental samples, and household products to try to figure out how the boy got the deadly bacteria. Testing found that two of four family members had antibodies against B. pseudomallei, suggesting past exposure. On August 10, investigators collected 55 household product samples and 38 environmental samples from around the family's large, rural property. All tested negative for B. pseudomallei. On October 6, the family agreed to let the investigators come back, at which point the investigators tested nine more environmental samples and 14 more household products.

One of those second-round products was a Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones, which was made in India and tested positive for B. pseudomallei, the room spray sold at Walmart in 2021 that caused the spread of the bacteria. On October 26, the CDC confirmed the finding and announced that the spray was the source of the bacterial strain in all four melioidosis cases, leading to the recall.