(CNN) – It was a mystery by any definition of the word: a rare tropical infection that had sick people in the non-tropical states of Minnesota and Kansas as well as Texas. The first patient to fall ill in March in Kansas died.
They were all infected with a bacterium known as Burkholderia pseudomallei, and the disease it causes is called melioidosis, characterized by nonspecific symptoms such as cough and shortness of breath, weakness, fatigue and nausea. It is most commonly seen in Thailand, Malaysia, Singapore and northern Australia and is found in contaminated soil and water.
It would not be expected in Central America, and certainly not in an aromatherapy spray fragrant with lavender and gemstones.
When Americans are diagnosed with melioidosis, it is typically associated with travel. But these cases occurred in the midst of a pandemic, as international travel was virtually non-existent. And none of the affected families had traveled.
The U.S. Centers for Disease Control and Prevention (CDC) issued a health warning in June when the three cases in Kansas, Minnesota and Texas were linked. When they found the source of the disease this month, it had infected four people and killed two of them.
Cold trails and fishing trips
The trail had cooled in Kansas, said CDC epidemiologist Dr. Jennifer McQuiston, who helped lead the study. The CDC worked with state health departments to try to figure out how humans had become infected with such an unusual bacterium.
“It really was a fishing expedition because we had no clue to guide us in any direction,” McQuiston told CNN.
“The teams were really looking at personal care products, lotions, soaps, foods, vitamins, things they might have been exposed to,” McQuiston said.
“Cleaning products, all that kind. The thing about Burkholderia pseudomallei is that it really needs a moist or wet environment to survive. It can survive in some forms of moisture where you would not normally think bacteria would survive, even in hand alcohol. “
Then in July, a patient died of melioidosis in Georgia. Genetic testing they related it to the other three cases.
The CDC teams doubled their searches and reviewed all the products they could find that could possibly be the source of the bacteria. Yet no hard evidence was found.
“They had tested hundreds of samples and it looked like it was hitting a dead end,” McQuiston said.
In a final effort, they returned to the last patient’s home for another look earlier this month.
“And on the special second search, they collected a sample from a bottle of air fresheners that had not been collected the first time, and this week we got PCR-positive results from the bottle of air fresheners for Burkholderia pseudomallei,” McQuiston said.
PCR – polymerase chain reaction – is the same type of laboratory test used to amplify genetic material for coronavirus testing. This time, he found genetic material from the suspicious bacteria.
There they found it: “Better Homes & Gardens aromatherapy room spray added lavender and chamomile essential oils with gemstones.” The product had been manufactured in India and sold at Walmart.
Walmart recalled the product last Friday.
“We were all so relieved to have something that pointed to a source of infection because our biggest concern was that whatever had caused the infection in the four previous cases could still pose a risk to people’s health,” McQuiston said.
“This showed us that it was true, our instincts on it were correct because there are households in America that have this bottle of fragrance in their homes and possibly spray it,” he added.
“That’s why we thought it was so important to come out with this information quickly, even though we’re still waiting for the results of the sequence confirmation to show that what came out of the bottle matched the patient from Georgia. The PCR results are what made us move forward with this announcement. “
The CDC has been able to link the bacterial strain to patients in Texas, Kansas and Minnesota. “So we have A connected to B, B connected to C, and the results of the sequence help us connect A to C,” McQuiston said.
It is not clear which ingredient in the spray may be contaminating. However, it may be the “gems”.
“The stones are collected from the environment and there are bacteria in the environment, so if the stones were not sterilized before they were integrated, that would be an option,” McQuiston said. “The other possibility is that another component has been contaminated and that the rocks have created a small microenvironment in that bottle so that the bacteria can grow,” he added. “So we do not know the importance of stones yet, but having stones in a scent bottle is definitely unusual. So that’s something I think we’re interested in looking at. ”
The same manufacturer made other fragrances using the “gemstones” that the CDC will investigate, McQuiston reported.
It is also unclear how humans can become infected with a spray. The victims do not appear to have inhaled it.
“Many people said they sprayed this on their pillows the night before they went to sleep, to give them a nice scent, so you can imagine there are uses for this, than not just spraying it in a room , where someone might be. in very close contact with the bacteria, ”said McQuiston.
Now, researchers will go back to see if the patient in Texas could have bought the same brand of spray.
“There was no mention of this specific product or brand in the introductory interview questions that I think states asked with these families,” McQuiston said. “I think a possible scent spray was mentioned in the room of a family member of the patient in Texas. So I think we will try to go back and dig a little deeper. ”
This is the hard part.
“We will never get that connection, as we have been away for several months now. The bottle may no longer be in the house, but I think an attempt will be made. “It’s probably not possible for the Kansas patient who died in March, or the Minnesota patient,” he said.
“But I would say we’ve heard that both people had a history of using fragrance products or essential oils, so I think you can imagine the possibility that that link is there.”
CDC epidemiologists are often referred to as disease detectives, and this is an example of why.
“You weigh the excitement of being able to put the pieces of this puzzle together with really the terrible knowledge that two people died and four families were dramatically shocked by this,” McQuiston said. “And I really think the awareness of the seriousness of this is what made our scientists work so hard to try to solve this mystery.”