Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray

Gee, Jay E.; Bower, William A.; Kunkel, Amber; Petras, Julia K.; Gettings, Jenna R.; Bye, Maria; Firestone, Melanie J.; Elrod, Mindy G.; Liu, Lindy; Blaney, David D.; Zaldivar, Allison; Raybern, Chelsea; Ahmed, Farah; Honza, Heidi; Stonecipher, Shelley; O’Sullivan, B.; Lynfield, Ruth; Hunter, Melissa; Brennan, Skyler; Pavlick, Jessica; Gabel, Julie; Drenzek, Cherie; Geller, Rachel; Lee, Crystal; Ritter, Jana M.; Zaki, Sherif R.; Gulvik, Christopher A.; Wilson, Wendy; Beshearse, Elizabeth; Currie, Bart J.; Webb, Jessica R.; Weiner, Zachary P.; Negrón, María; Hoffmaster, Alex R.

doi:10.1056/nejmoa2116130

Cited by 50 publications

(32 citation statements)

References 19 publications

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“…In addition, the potential for further spread via transregional trade was recently emphasized by a sporadic outbreak in the USA during March–July 2021, in which four melioidosis patients were identified in different states who had no history of overseas travel and were infected with the same strain related to people from South Asia. It was ultimately traced to an aromatherapy spray from India, which was presumably contaminated during manufacture [ 37 ]. In China, the incidence has been increasing steadily since 2004, the year when a national health surveillance program for melioidosis was launched [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

A novel lytic phage potentially effective for phage therapy against Burkholderia pseudomallei in the tropics

Wang

Dance

et al. 2022

Infect Dis Poverty

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Background Burkholderia pseudomallei is a tropical pathogen that causes melioidosis. Its intrinsic drug-resistance is a leading cause of treatment failure, and the few available antibiotics require prolonged use to be effective. This study aimed to assess the clinical potential of B. pseudomallei phages isolated from Hainan, China. Methods Burkholderia pseudomallei strain (HNBP001) was used as the isolation host, and phages were recovered from domestic environmental sources, which were submitted to the host range determination, lytic property assays, and stability tests. The best candidate was examined via the transmission electron microscope for classification. With its genome sequenced and analyzed, its protective efficacy against B. pseudomallei infection in A549 cells and Caenorhabditis elegans was evaluated, in which cell viability and survival rates were compared using the one-way ANOVA method and the log-rank test. Results A phage able to lyse 24/25 clinical isolates was recovered. It was classified in the Podoviridae family and was found to be amenable to propagation. Under the optimal multiplicity of infection (MOI) of 0.1, an eclipse period of around 20 min and a high titer (1012 PFU/ml) produced within 1 h were demonstrated. This phage was found stabile at a wide range of temperatures (24, 37, 40, 50, and 60 °C) and pH values (3–12). After being designated as vB_BpP_HN01, it was fully sequenced, and the 71,398 bp linear genome, containing 93 open reading frames and a tRNA-Asn, displayed a low sequence similarity with known viruses. Additionally, protective effects of applications of vB_BpP_HN01 (MOI = 0.1 and MOI = 1) alone or in combination with antibiotics were found to improve viability of infected cells (70.6 ± 6.8%, 85.8 ± 5.7%, 91.9 ± 1.8%, and 96.8 ± 1.8%, respectively). A significantly reduced mortality (10%) and a decreased pathogen load were demonstrated in infected C. elegans following the addition of this phage. Conclusions As the first B. pseudomallei phage was isolated in Hainan, China, phage vB_BpP_HN01 was characterized by promising lytic property, stability, and efficiency of bacterial elimination during the in vitro/vivo experiments. Therefore, we can conclude that it is a potential alternative agent for combating melioidosis. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

A novel lytic phage potentially effective for phage therapy against Burkholderia pseudomallei in the tropics

Wang

Dance

et al. 2022

Infect Dis Poverty

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“…Investigations led by the US CDC have shown the power of classical ‘shoe leather’ outbreak case investigation combined with modern pathogen genomic studies to pinpoint the source of unexpected cases of melioidosis. A cluster of four nontravel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas were found on whole-genome sequencing of B. pseudomallei to be caused by the same strain of B. pseudomallei that was recovered from an aromatherapy spray product imported from India [29 ▪ ]. Two cases were fatal, including a child co-infected with SARS-CoV-2, who had disseminated melioidosis, including extensive brain involvement.…”

Section: Epidemiologymentioning

confidence: 99%

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination

Currie

2022

Current Opinion in Infectious Diseases

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Purpose of reviewMelioidosis and its causative bacterium Burkholderia pseudomallei are being found in unexpected locations and bacterial genotyping is providing new insights into global spread and where and how individuals are being infected. This review summarizes recent studies covering the epidemiology, diagnosis, treatment, and prevention of melioidosis. Recent findingsWhole-genome sequencing of B. pseudomallei from patients and environmental sampling is informing the phylogeography of B. pseudomallei at regional, continental, and global levels, while also defining the epidemiology for individual cases. The situation in Africa remains the most unresolved, while the evolving story of B. pseudomallei in the Americas may establish that B. pseudomallei is endemic in parts of southern USA. Guidelines for diagnosis and treatment of melioidosis are well established, and published mortality has decreased from 50% or higher to 10% or lower in some countries but access to laboratory and therapeutic resources are not available or are extremely limited in many melioidosis-endemic regions.

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“…Unprotected handling of or contact with lab specimens has resulted in melioidosis in some lab workers 9,10, 44. In November 2021, the CDC confirmed that the four non-travel-associated US cases were linked to aromatherapy room spray manufactured in India 15,16,45,46…”

Section: Risk Factorsmentioning

confidence: 99%