After several days of sickness, a 5-year old boy from Georgia was brought to the emergency department on July 12. After several days of sickness, he was vomiting and had a sore throat. His heart rate was extremely fast. His fever rose to over 102 degrees.
The child was admitted to the hospital by doctors to be monitored and to maintain his proper hydration. His breathing became difficult at night and he was diagnosed with Covid-19.
The doctor immediately began a standard treatment, which included steroids and an antiviral drug called Remdesivir.
He did not get better. He died after four days in hospital.
The coronavirus was later found in the boy's lungs and upper airways. It also revealed something unexpected: bacteria called Burkholderia pseudomallei was found in the boy's liver, brain, and lungs.
Investigators would be able to solve three additional cases of Burkholderia pseudomallei infections that were reported earlier in the year in different states. The New England Journal of Medicine published details of the four cases Wednesday.
A microscopic mystery solved
The bacteria Burkholderia pseudomallei is almost never found in the United States. Instead, they are often found in soil and water in South and Southeast Asia.
The boy's family claimed that they have never traveled to other countries. The family did not test the soil and water supply outside their home.
Burkholderia pseudomallei is also possible to inhale and aerosolize. Investigators therefore tested the products in the boy's house.
Julia Petras (a Centers for Disease Control and Prevention officer and epidemic intelligence service officer) said that it was an "arduous" investigation. She said that investigators collected dozens of samples from the boy's house over the course of several months.
Investigators found the bacteria in an aromatherapy spray that was used in the house three months later in October. The product, which was a lavender and chamomile aromatherapy room spray with gemstones from Better Homes & Gardens Essential oil Infused Aromatherapy Space Spray With Gemstones, was imported from India. It is available at 55 Walmart stores as well as online.
Petras stated, "When we got the confirmation, that was a tremendous relief."
Investigators solved three other cases of Burkholderia pseudomallei infection earlier in the year by discovering the bacteria in an aromatherapy product. The same strain of bacteria was found in each of these patients, indicating that they also used the contaminated spray bottle.
These cases were made public for the first time in October when the CDC published an alert regarding the aromatherapy spray. The Consumer Product Safety Commission announced the recall of nearly 4,000 bottles of the product by Walmart. It also announced five additional scents that share the same product name: lavender, lemon and mandarin, peppermint, lime and eucalyptus, sandalwood, vanilla, and sandalwood.
A difficult diagnosis
Melioidosis is caused by Burkholderia pseudomallei. If caught early, it can be treated with intravenous antibiotics.
Because the bacteria is so rare in the U.S. however, symptoms of melioidosis may be mistakenly misdiagnosed with other respiratory diseases such as the flu or Covid, or even tuberculosis.
The new report details the cases of four patients who initially presented with a variety of vague symptoms such as fatigue, shortness or breathlessness, fever, and nausea.
A Texas 4-year-old girl was one of the victims. Her family had to seek medical attention several times because she was vomiting and had fevers exceeding 103 degrees. Later, investigators confirmed that the family owned the aromatherapy spray.
Doctors suspected that the girl might have a urinary tract infection, and prescribed a range of antibiotics. She was admitted to hospital with septic shock within days. This is a condition that causes low blood pressure and can cause organ damage.
The girl survived. The study authors noted that the girl was still nonverbal three months later after she left the hospital.
Both the parents of the boy and the girl told investigators that they had used the spray on pillows and bedding at times.
Two other patients were both adults, both aged 53. A Minnesota man went to the hospital complaining of weakness and confusion. His fever rose to 104 degrees and he experienced severe pain in his hips.
Later, he was discharged but his mental state had not improved.
A Kansas woman who suffered from breathing difficulties and weakness was later admitted to a hospital. She then went into septic shock. She died nine days later.
According to Dr. Jill Weatherhead (assistant professor of tropical medicine, infectious diseases, Baylor College of Medicine in Houston), melioidosis can be caused by normal use of contaminated room sprays.
Weatherhead, who wasn't involved in the CDC investigation, stated that "We know you could get this infection by inhalation into your lungs." "Unfortunately, in this instance, the bacteria was already being Aerosolized. It can cause illness if you inhale it.