By NewsDesk  @infectiousdiseasenews

In a follow-up on the several non-travel associated melioidosis cases in the United States, the Georgia Department of Public Health, with assistance from the Centers for Disease Control and Prevention (CDC), is investigating a fatal case of Burkholderia pseudomallei infection (i.e., melioidosis) identified in late July 2021.

Georgia
Image/Clker-Free-Vector-Images

Based on genomic analysis, this case in Georgia closely matches the three cases previously identified in Kansas, Minnesota, and Texas in 2021, indicating they all most likely share a common source of exposure.

The most recent case died in the hospital and was identified post-mortem in late July 2021 in Georgia. This was preceded by the first case, which was fatal, was identified in March 2021 in Kansas. The second and third cases, both identified in May 2021 in Minnesota and Texas, were hospitalized for extended periods of time before being discharged to transitional care facilities.

The four cases include both children and adults. Two cases are female, and two cases are male. None of the cases had a history of traveling outside of the continental United States.

Burkholderia pseudomallei, the causative agent of melioidosis, is a Tier 1 select agent that can infect animals and humans. Cases are most common in areas of the world with tropical and sub-tropical climates. Most cases in the United States occur in persons returning from a country where the disease is endemic. These four cases are unusual because no recent travel outside the United States has been identified.

Melioidosis symptoms are nonspecific and vary depending on the type and site of infection. Symptoms may include localized pain or swelling, fever, ulceration, abscess, cough, chest pain, high fever, headache, anorexia, respiratory distress, abdominal discomfort, joint pain, disorientation, weight loss, stomach or chest pain, muscle or joint pain, and seizures. Mortality varies depending on disease severity and clinical presentation, with case fatality ranging between 10-50% worldwide.1 People with certain conditions are at higher risk of disease when they come in contact with the bacteria. The most common factors that make a person more likely to develop disease include diabetes, kidney disease, chronic lung disease, and excessive alcohol use. Melioidosis is confirmed by culture. Testing must be conducted by trained personnel because some automated identification methods in clinical laboratories may misidentify B. pseudomallei as a different bacterium. Treatment of melioidosis requires long-term antibiotic therapy.

Genomic analysis of the strains strongly suggests a common source, such as an imported product or animal; however, that source has not been identified to date despite environmental sampling, serological testing, and family interviews.