New tragic details of US child who died from tropical bacteria in room spray

A previously healthy 5-year-old boy in Georgia died of abacterial infections linked to imported room sprays sold at Walmart. New information was presented Tuesday at the International Conference on Emerging Infectious Diseases, hosted by the Centers for Disease Control and Prevention in Atlanta.

The tragic new details of the boy's cases—presented by epidemiologist Jessica Pavlick of the Georgia Department of Public Health—have newfound significance for the US. In the year since the boy's death, the tropical soil bacterium behind his deadly infection has been found in environmental samples in southern Mississippi. The bacterium—Burkholderia pseudomallei—is now considered endemic to the Gulf Coast region, creating an ever-present threat to people in the area.

Tragic infection

The CDC has suspected for a long time that B. pseudomallei could be present in the continental US rather than being brought in via imported animals and products. The US has seen an average of 12 cases of B. pseudomallei in the last few years.

CDC researchers think that B. pseudomallei had become a permanent resident rather than being an occasional interloper. After an unexplained case in southern Mississippi in 2022, investigators finally caught B. pseudomallei in US environmental samples.

Advertisement Though melioidosis cases are rare even in places where B. pseudomallei is most prevalent—namely in Southeast Asia and northern Australia—when they occur, they can be difficult to diagnose and treat, and it can easily turn deadly. Awareness of the disease and rapid diagnosis are critical. This was sadly not the case for the 5-year-old in Georgia.

The boy fell sick. The CDC issued a nationwide alert on June 30 over three more melioidosis cases in three other states. Despite the scattered cases, genetic analyses of the B. pseudomallei isolates indicated that they were all related.

An adult in Kansas died of the disease in March of 2021. There were two other cases in May, one of which was an adult in Minnesota who survived. State and CDC health investigators knew the cases were connected and that an imported product or animal was likely to blame, but they hadn't figured out a common source. The answer would be revealed by the tragic death of the boys in Georgia.

The boy's case was laid out. The boy began to feel unwell on July 7, a week after the CDC's melioidosis alert. He was previously considered healthy and had no underlying health issues. The boy was admitted to the hospital on July 12 after testing positive for the respiratory syncytial virus. He was taken to a children's hospital because of respiratory failure. He was taken to the intensive care unit. He was intubated on the 14th. He died on July 16 after becoming weak.

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Testing

Post-mortem testing by the hospital laboratory showed a B. pseudomallei infections. There was a bacterium in the boy's body. The CDC confirmed the link to the other three cases on July 29 after the state health department designated it a presumptive case.

Melioidosis has been described as the "great mimicker" due to its symptoms being similar to other serious conditions. The infections can be established through a number of different routes. If there is a break in the skin of a person, they can be exposed to the germ if they ingest soil, water, or food.

Delayed treatment can allow the B. pseudomallei to spread to other parts of the body, leading to a deadly disseminated infections 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 had picked up 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 and gardens lavender and chamomile essential oil infused aromatherapy room spray with gemstones, which was made in India and tested positive for B. pseudomallei The spray was the source of the strain of melioidosis that was found in four cases.