Rare Tropical Disease Linked To Aromatherapy Spray Killed 2

ATLANTA, GA — A 5-year-old boy in Georgia and a 53-year-old woman in Kansas died from a rare tropical disease — typically found in South Asia — that was linked to an imported aromatherapy spray product sold at Walmart stores.

That's according to new details published Thursday in the New England Journal of Medicine, which outlined four cases of melioidosis in Georgia, Kansas, Minnesota and Texas, that were linked to bottles of room sprays from Better Homes and Gardens. The bottles were labeled as a "highly fragranced essential oil and semi-precious stone infused room spray" with a "lavender and chamomile" scent.

And now, the authors say health care professionals should more closely consider melioidosis in patients showing similar symptoms, even if they haven't traveled to places where the disease is endemic.

As Patch previously reported, Walmart recalled about 3,900 bottles of "Better Homes and Gardens Essential Oil Infused Aromatherapy Room Spray with Gemstones." The aromatherapy room spray was sold at 55 Walmart stores and online from February 2021 through October 2021 for about $4.

One bottle of the essential oil sprays was found to contain Burkholderia pseudomallei, a dangerous bacteria that lives in soil and water and causes the melioidosis infection when ingested, breathed or absorbed through the skin.

The infection, also called Whitmore’s disease, can lead to skin abscesses in the absence of fever, pneumonia, sepsis, organ abscesses, genital infection, and inflamed brain or spinal cord.

Most melioidosis cases are reported in Thailand, Malaysia, Singapore and Northern Australia, as well as several other South Asia countries, though there have been cases reported in Puerto Rico, the British and U.S. Virgin Islands, Central and South America, and parts of Africa and the Middle East, according to the federal Centers for Disease Control and Prevention.

But in America, cases are exceedingly rare. About a dozen are reported to the CDC each year, and the vast majority are linked to travel to areas where melioidosis is endemic. So experts were puzzled when two people in America died from the bacteria, and none of the four in the cluster of cases — which occurred over a period of just a few months — had traveled internationally.

After testing numerous items the four patients were exposed to, researchers connected the strain of bacteria to an aromatherapy spray bottle that was imported from India.

New Details In Melioidosis Cases

All four patients were hospitalized early during their clinical course, the researchers said.

Initial tests did not reveal a bacterial infection.

Kansas Case

In the first case, a 53-year-old woman went to an emergency room March 13 in Kansas. The woman fell ill with shortness of breath, cough, malaise and weakness. She also had an extensive past of medical issues, such as chronic obstructive pulmonary disease, or COPD, cirrhosis due to hepatitis C, coronary artery disease, hypothyroidism, psoriatic arthritis and drug and alcohol abuse.

She was given antibiotics for pneumonia and a urinary tract infection, the researchers said, as steroids for the COPD. But her condition deteriorated to the point where she was moved to an intensive care unit on day four and given a wider array of antibiotics. Two days later, she developed septic shock and had to be placed on a ventilator. She died on her ninth day in the hospital. A post-death examination was not performed, the researchers said.

Texas Case

Two months later, a 4-year-old girl in Texas fell ill.

She visited a doctor May 31 after three days with a fever, decreased activity, loss of appetite and a day of vomiting.

The girl had no significant medical history and hadn't traveled out of the country. After an unremarkable exam, she was diagnosed with viral gastroenteritis.

Two days later, she was taken to an urgent care clinic because the fever continued, now at 103 degrees. She was diagnosed with a urinary tract infection after a test of her urine, and was sent home with a penicillin-type antibiotic used to treat bacterial infections.

The girl's condition initially improved, but she returned to the emergency department two days later with intermittent fevers, vomiting and progressive lethargy. She had a fever of nearly 101 degrees and was tachycardic and tachypneic, meaning her heart was beating abnormally fast and her breathing was atypically rapid. Additionally, her white-cell count was 16,000 per cubic millimeter, lower than the 17,7000 she had just two days earlier.

The girl tested positive for human rhinovirus and enterovirus, and she was admitted into a children's ICU. She was diagnosed with septic shock and meningoencephalitis, or serious inflammation of the brain and membranes that protect the brain and spinal cord.

She received ceftriaxone, an anti-bacterial medication, and had to be intubated due to falling blood-oxygen levels. She was also given anti-inflammatory drugs. But her breathing and neurologic conditions continued to decline while in the ICU, and she had to receive broader antibiotics. She was eventually diagnosed with melioidosis after a blood culture grew the bacteria, which was initially misidentified. She received drug treatments for eight weeks, followed by months of eradication therapy.

"Three months after discharge, the patient remained wheelchair-bound and nonverbal," the researchers said

Minnesota Case

Also in late May, a 53-year-old man was rushed to a Minnesota emergency room after family members found him weak and in an altered mental state.

The man had a history of medical issues, including a dependence on alcohol and tobacco. He, too, hadn't traveled internationally.

An MRI of his brain showed his condition was consistent with Wernicke’s encephalopathy. The neurological disease is often characterized by confusion, an inability to coordinate voluntary movement and eye abnormalities. He was admitted to a hospital for treatment of acute metabolic encephalopathy. The man experienced hip pain while in the hospital, and additional MRI images showed some degeneration changes.

After six days in the hospital, he was discharged to a transitional care facility.

But on June 6, just eight days after his initial emergency room visit, the man was moved back to the ER with a 104-degree fever and deteriorating mental state. His oxygen saturation had fallen to 90 percent.

He was given medication after chest scans showed evidence of pneumonia. Those meds were later switched to However, meropenem was later switched to antibiotics after he developed a new rash. The man's fever waned, and he was weaned off oxygen.

On day six, the fever returned and the pain in his right hip worsened. An MRI showed acute inflammation, including myositis — a rare disease characterized by inflamed muscles that can cause muscle fatigue and weakness — a possibly septic hip and inflammation in his right pelvic bone.

As in other cases, blood cultures initially misidentified the bacteria. The Burkholderia pseudomallei was later identified on blood cultures and from a sample of his right hip joint. The patient was discharged to a transitional care facility June 23. He completed eight weeks of intravenous drugs and was given a schedule for eradication therapy. But even after discharge, he remained confused, researchers said, and showed evidence of osteonecrosis of the infected hip joint. In the disease, a lack of blood causes the bone to break down faster than the body can replenish new bone. The bone starts to die and may break down.

Georgia Case

In Georgia, a 5-year-old boy was taken to the emergency room July 12 after three days of weakness, fever, tongue swelling, sore throat, nausea and vomiting.

Similar to the girl in Texas, he did not have a history of major medical issues. And like the other three cases, he hadn't traveled outside the country.

The boy had a fever of about 102 degrees and also had a an abnormally rapid heart beat, as well as intermittent periods of atypically rapid breathing. He also had an elevated white-cell count. Tests showed he was positive for severe acute respiratory syndrome coronavirus 2, more commonly known as the coronavirus. The virus causes the COVID-19 disease.

The boy was admitted to the hospital for observation and rehydration. But his oxygen saturation levels fell overnight, and he was moved to an ICU due to concerns of imminent breathing failure. After chest images later showed opacities and fluid in his lungs, the boy was given remdesivir and dexamethasone, common treatments for COVID-19. He as also given anti-inflammatory and anti-bacterial drugs, and later an antibiotic used to treat certain serious bacterial infections.

But the boy's fever persisted and his breathing continued to deteriorate. On the third day in the hospital, his right arm fell weak. A day later, his pupils became dilated and nonreactive. A CT scan showed a large cerebral infarct. Also called ischemic stroke, the infarction happens when there's disrupted blood flow to the brain, and can cause parts of the brain to die off.

The boy's heart and lungs progressively deteriorated despite efforts to resuscitate him. He was left in a vegetative state and died on his fourth day in the hospital.

Tests performed during his autopsy showed the bacteria Burkholderia pseudomallei in his lungs, liver, spleen and brain, as well as COVID-19 in his lungs.

Bacteria Links Four Deaths Across Four States

Melioidosis was detected in all four patients, who each fell severely ill and who hadn't traveled to places where melioidosis was endemic. However, melioidosis might not have been initially considered because the four had not traveled to areas where the disease is endemic. Additionally, initial tests didn't uncover a Burkholderia pseudomallei infection.

Furthermore, the patients in Kansas, Texas and Georgia all received glucocorticoid therapy prior to being diagnosed with melioidosis, which could have contributed to the severity of disease, researchers said.

The Georgia boy's coronavirus infection also likely contributed to the severity of his illness. In a previous case, the CDC found that the coronavirus may have reactivated a previous fatal coinfection of Covid-19 and melioidosis in which the SARS-CoV-2 infection is thought to have reactivated a latent Burkholderia pseudomallei infection.

In discussing the four cases, the researchers highlighted the risks associated with exposure to imported products from areas where the bacterium is endemic.

"Health care providers should consider melioidosis in patients with a compatible illness, even if they do not have a history of travel to melioidosis-endemic areas," the study said. "In addition, patients who have acute respiratory or neurologic symptoms that do not have a response to initial treatment may be candidates for closer assessment for melioidosis."