Fatal Burkholderia pseudomallei Infection Initially Reported as a Bacillus Species, Ohio, 2013

Abstract

Abstract. A fatal case of melioidosis was diagnosed in Ohio one month after culture results were initially reported as a Bacillus species. To identify a source of infection and assess risk in patient contacts, we abstracted patient charts; interviewed physicians and contacts; genetically characterized the isolate; performed a Burkholderia pseudomallei antibody indirect hemagglutination assay on household contacts and pets to assess seropositivity; and collected household plant, soil, liquid, and insect samples for culturing and real-time polymerase chain reaction testing. Family members and pets tested were seronegative for B. pseudomallei. Environmental samples were negative by real-time polymerase chain reaction and culture. Although the patient never traveled internationally, the isolate genotype was consistent with an isolate that originated in Southeast Asia. This investigation identified the fifth reported locally acquired non-laboratory melioidosis case in the contiguous United States. Physicians and laboratories should be aware of this potentially emerging disease and refer positive cultures to a Laboratory Response Network laboratory.

Phylogeography ofBurkholderia pseudomalleiIsolates, Western Hemisphere

“…The ITS type CE and the location of this subclade support an origin outside the Western Hemisphere, more likely in Asia, which supports the earlier proposal that PB08298010 might have resulted from exposure to contaminated medical supplies from Southeast Asia ( 10 , 36 ). A similar situation might also be true for a fatal case in a patient in Ohio, USA, who had no travel history outside the continental United States ( 32 ). Isolate OH2013 groups with isolates from Thailand and is clearly not associated with those in the Western Hemisphere.…”

A Review of Melioidosis Cases in the Americas

“…The patient's husband was a U.S. veteran with travel history to Hong Kong, Japan, Mexico, and the Philippines. 21 The source of infection for the other three cases from U.S. mainland, [35][36][37] one case from Hawaii, 38 and all four cases from Mexico (Supplemental Appendix 1) remains unknown.…”

“…26 A bit more puzzling are the three cases reported from the United States with no travel history outside the U.S. mainland. [35][36][37] One was reported as a chronic case. 35 In the other two 36,37 cases, extensive investigations took place, including detailed travel history, occupational history, and recreation and hobbies; in addition, environmental sampling around the home environment was carried out and serology was conducted on family members and pets.…”

“…[35][36][37] One was reported as a chronic case. 35 In the other two 36,37 cases, extensive investigations took place, including detailed travel history, occupational history, and recreation and hobbies; in addition, environmental sampling around the home environment was carried out and serology was conducted on family members and pets. In both cases, no source of B. pseudomallei was identified and there was no serologic evidence of exposure in family members or pets.…”

“…The most recent case in an Ohio resident was found to be internal transcribed spacer (ITS) type CE, which is commonly seen in SE Asia and Australia but not in the Western Hemisphere. 37,43,44 Since melioidosis is not considered endemic to the United States (mainland), 45 it raises the question of whether contaminated medical supplies (intravenous supplies, medications, etc.) could have been imported from an endemic area, leading to a nosocomial acquisition of B. pseudomallei.…”