By Maggie Fox, CNN

(CNN) – It was a mystery however you define the word – a rare tropical infection that had sickened people in the decidedly non-tropical states of Minnesota and Kansas, as well as Texas. The first patient to fall ill, in Kansas in March, has died.

They have all been infected with a bacteria known as Burkholderia pseudomallei, and the disease it causes is called melioidosis, which is 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 soil and contaminated water.

This is not expected in Central America, and certainly not in a lavender scented aromatherapy spray with precious stones.

Usually when Americans are diagnosed with melioidosis, it is associated with travel. But these cases emerged in the midst of a pandemic, when international travel was virtually non-existent. And none of the affected families had traveled.

United States Centers for Disease Control and Prevention issued a health alert last June, when the three cases in Kansas, Minnesota and Texas were linked. By the time they found the source this month, it had sickened four people and killed two.

Cold trails and fishing expeditions

The trail had turned cold in Kansas, said CDC epidemiologist Dr Jennifer McQuiston, who helped lead the investigation. The CDC worked with state health departments to try to understand how people got infected with such an unusual virus.

“It was really a fishing expedition because we didn’t have any early clues to guide us in any direction,” McQuiston told CNN.

“The teams really looked at personal care products, lotions, soaps, foods, vitamins – things they might have been exposed to,” McQuiston said.

“Cleaning supplies – all those kinds of things. The problem with Burkholderia pseudomallei is that it really needs a damp or wet environment to survive. It can survive in certain types of humidity that you wouldn’t normally think of. to bacteria surviving in, so even hand sanitizers. “

Then in July, a patient died of melioidosis in Georgia. Genetic test linked it to the other three cases.

Teams at the CDC doubled down on their searches, going through any products they could find that could possibly be a source of the bacteria. Even so, there was no smoking gun.

“They had tested several hundred specimens and it looked like it ended in a dead end,” McQuiston said.

In a last ditch effort, they returned to the last patient’s home for another look earlier this month.

“And in this second research in particular, they collected a sample from a bottle of deodorant that was not collected the first time, and this week we got positive PCR results from that bottle of deodorant for Burkholderia pseudomallei. “said McQuiston. .

PCR – polymerase chain reaction – is the same type of lab test used to amplify genetic material for coronavirus testing. This time he found genetic material from the bacterial crime suspect.

There they found it: “Better Homes & Gardens Aromatherapy spray infused with lavender and chamomile essential oil with gemstones.” The product had been made in India and sold at Walmart.

Walmart recalled the product on Friday.

“We were all so relieved to have something that pointed to a source of infection because our biggest concern was that whatever caused the infection in those four previous cases may still be present and pose a health risk. people, ”McQuiston said.

“It showed us it was true – our instincts were right because there are households in America that have this bottle of air scent in their house, potentially vaporizing it,” she added.

“This is why we thought it was so important to get this information out quickly, even though we are still waiting for the confirmation results of the footage showing that what came from the bottle matched the patient from Georgia. PCR are what drove us to move forward with this advert.

The CDC was 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 will help us connect A to C,” McQuiston said.

Precious “healing” stones?

It is not clear which ingredient in the spray may be the contaminant. It could be the “gems”, however.

“The rocks are collected from the environment and there are bacteria in the environment, so if the rocks haven’t been sterilized before they come in, that’s a possibility,” McQuiston said. “The other thing is the possibility that another component was contaminated and the rocks created a little microenvironment in that bottle for bacteria to thrive,” she added. “So we don’t really know the meaning of rocks yet, but having rocks in a perfume bottle is definitely unusual. So that’s something I think we’re interested in looking into.”

The same manufacturer has made other fragrances using “gemstones” that the CDC will be looking at, McQuiston said.

It is also not known how people can get infected from a spray. It doesn’t necessarily seem like the victims inhaled it.

“A lot of people have said that they spray this on their pillows at night before going to sleep, to give them a pleasant scent – so you can imagine that there are, there are uses of this, even in- beyond just spraying a room, where it could put someone in very close contact with the bacteria, ”McQuiston said.

Now investigators will return to see if the patient in Texas could have purchased the same brand of spray.

“There was no mention of this specific product or brand in the initial interview questions I think States undertook with these families,” McQuiston said. “I believe there was a mention of a possible air freshener in a family member of the patient from Texas. So I think we’ll try to go back and dig a little deeper.”

This is the difficult part.

“We may or may not make that connection, given that we are several months away now. The bottle may not be in the house anymore, but I think there is going to be an attempt.” That likely won’t be possible for the Kansas patient, who died in March, or the Minnesota patient, she said.

“But I’ll say we’ve heard that these two people used to use scent products or essential oil type products, so I think you can imagine the possibility that that connection exists.”

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 horrific knowledge that two people have died and that four families have been significantly affected by it,” McQuiston said. “And I really think that knowing how bad it was is what made our scientists work so hard to try and solve this mystery.”

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