(CNN) It was a mystery by any definition of the word: a rare tropical infection that was making people sick in the decidedly non-tropical states of Minnesota, Kansas, and Texas. The first patient to fall ill with the disease died in Kansas in March.
All were infected with the bacterium Burkholderia pseudomallei, which causes a disease called melioidosis, characterised by non-specific symptoms such as coughing, shortness of breath, weakness, fatigue and nausea. The disease is most common in Thailand, Malaysia, Singapore and northern Australia, where it is present in soil and contaminated water.
That’s not expected in the Midwest, and it’s certainly not expected with jeweled lavender scented aromatherapy sprays.
Typically, when Americans are diagnosed with melioidosis, it’s travel-related, but these cases occurred during the pandemic, when international travel was virtually impossible, and none of the infected family members had traveled.
The US Centers for Disease Control and Prevention issued a health alert last June after three cases in Kansas, Minnesota and Texas were linked, and four people fell ill, two of whom died, before the source of infection was discovered this month.
Cold Roads and Fishing Expeditions
The cause remains a mystery in Kansas, said Dr. Jennifer McQuiston, a CDC epidemiologist who led the investigation, and the CDC worked with the state health department to try to figure out how people could have become infected with such an unusual pathogen.
“At first, it was really a blind search because there weren’t any clues to guide us in any direction,” McQuiston told CNN.
“The team thoroughly investigated anything they may have come into contact with, including personal care products, lotions, soaps, foods and vitamins,” McQuiston said.
“Cleaning products, everything. Burkholderia pseudomallei needs moisture and a moist environment to survive. It can survive in moisture where you wouldn’t normally think of bacteria surviving, so it can survive in hand sanitizer.”
Then in July, a patient in Georgia died from melioidosis, and genetic testing linked him to three other cases.
The CDC team further expanded their search, testing every product that could be the source of the bacteria, but still found no conclusive evidence.
“They tested hundreds of specimens and seemed to be at an impasse,” McQuiston said.
As a last resort, they returned to the last patient’s home earlier this month to re-examine him.
“And during that second search, samples were taken from an air freshener bottle that was not taken during the first search, and this week that air freshener bottle tested positive by PCR for Burkholderia pseudomallei,” McQuiston said.
PCR (polymerase chain reaction) is the same type of test used to amplify genetic material in coronavirus tests, and this time, genetic material was found in the suspected bacterial crime.
What they found was Better Homes & Gardens Gemstoned Aromatherapy Room Spray with Lavender & Chamomile Essential Oils, made in India and sold at Walmart.
Walmart recalled the product on Friday.
“We’re all relieved to have found something that suggests a source of infection, because our biggest concern was that the agent that caused the previous four cases might still be out there somewhere and pose a risk to people’s health,” McQuiston said.
“Our research shows that to be true, and our intuition was correct, because there are households in the US that have bottles of air freshener in their homes and spray them,” she added.
“That’s why we thought it was so important to release this information quickly, even though we’re still waiting for sequence confirmation that what came out of the bottle matches that of the patient in Georgia. The PCR test results are what prompted us to move forward with this announcement.”
The CDC has been able to link the strain to patients in Texas, Kansas and Minnesota. “So strain A is linked to strain B, strain B is linked to strain C, and the sequencing results will help link strain A to strain C,” McQuiston said.
A “healing” gem?
It is unclear which component in the spray is the contaminant, but it could be a “gemstone.”
“The stones were collected from the environment, and the environment has bacteria living in it, so that’s a possibility if the stones hadn’t been sterilized before they were bottled,” McQuiston said. “The other possibility is that another component was contaminated and the stones created a little environment in the bottle where bacteria could grow,” she added. “So we don’t really know what the stone means yet, but it’s definitely unusual to have stones in a perfume bottle, so that’s something we want to look at.”
McQuiston said the same manufacturer also makes other fragrances that use “gemstones,” which the CDC plans to investigate.
It’s also unclear how people become infected by the spray – victims don’t necessarily seem to inhale it.
“A lot of people spray their pillows at night before they go to sleep to give them a nice scent, so I can imagine that one way to do this is not just spraying the room, but using this spray in areas where people may come into contact with germs in very close proximity,” McQuiston said.
Investigators will now be re-examining whether the Texas patient may have purchased the same brand of spray.
“I don’t think this particular product or brand was mentioned at all in the initial interviews that state officials conducted with the families,” McQuiston said. “I think one of the family members in Texas mentioned room spray perfume, so I think we’re going to look at this again a little more carefully.”
This is the difficult part.
“It’s been several months now, so I don’t know if we’ll know the link. The bottle may no longer be in the house, but I think an attempt will be made,” she said. In the case of the Kansas patient who died in March or the Minnesota patient, that probably won’t be possible, she said.
“But I have heard that they both have used scented products and essential oil-type products, so I can imagine there could be a connection.”
CDC epidemiologists are often called disease detectives, and this is one example of why.
“You have to balance the excitement of being able to put this puzzle together with the horrific fact that, in reality, two people were killed and four families were deeply affected,” McQuiston said, “and I think knowing how serious this is is what has driven scientists to work so hard to solve this mystery.”
