U.S. melioidosis enigma? CDC finds genetic match in imported spray bottles

From Oct. 22-26, the U.S. Centers for Disease Control and Prevention announced a sequence of solutions to the 2021 enigma of how four non-travelers in four non-adjacent states developed melioidosis including two deaths and two involving the brain. As of Oct. 26, whole genome sequencing established that a match for the Burkholderia pseudomallei in the four patients was found in at least two spray bottles sold by Walmart in 56 U.S. stores and online (“Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones”). 

The first spray bottle found to have the B. pseudomallei was found in the home of the patient from Georgia. The location of the second positive spray bottle was not stated when it was reported in CDC’s Oct. 26 media release, which indicated only that “[s]ince Friday, CDC testing of an additional bottle of the spray has tested positive for the bacteria.” 

These spray bottles were reported by CDC to have been “manufactured in India.” At first glance, prior to further detailed testing of what component of the spray bottle was the precise source of the bacteria, India would be consistent with the sequencing of the organism that showed it was closest to isolates from “South Asia.”  

In my opinion, however, it is best to wait to be sure what component of the spray bottle (e.g., the gemstones, the scents, the water, the essential oils, the bottles themselves and any other components in the bottle) were the source of the bacteria and where exactly each component originated prior to the final manufacture site in India.   

It has not been reported that these aromatherapy spray bottles were sold anywhere in the world other than the USA. CDC provided a link to a list from Walmart of all 56 stores (to my count, 55 in some reports) where these spray bottles were sold.  

To my review of these 56 stores, only one of the four patients lived in a state that did not have any of these stores listed. Unless this patient’s infection can be documented to an online purchase of one of these contaminated spray bottles, then how he was infected is still an enigma requiring investigation. In my view, this patient’s melioidosis due to B. pseudomallei strongly suggests exposure to other people who are epidemiologically linked to him.