What Are the Symptoms of Melioidosis? CDC Confirms a Second Fatality Due to This Rare Bacterial Infection

The Centers for Disease Control and Prevention (CDC) on Monday confirmed a second death due to a rare disease known as melioidosis.

Genomic analysis by the CDC revealed the new case, which was identified in late July in Georgia, closely matches bacterial strains in three previously reported cases in Kansas, Minnesota, and Texas.

The potentially deadly bacterial illness is normally found in tropical regions. In light of the new fatality, the agency is asking clinicians to keep melioidosis in mind as a potential diagnosis when patients don't respond to normal antibiotics, even if someone hasn't traveled outside the US.

The four cases involve both adults and children, two males and two females, according to the CDC. One case was identified in March in Kansas, and that person died. Two others were diagnosed in May in Minnesota and Texas. Both individuals were hospitalized for an extended period of time before their discharge to transitional care facilities.

The CDC says all four patients had symptoms that ranged from a cough and shortness of breath to weakness, fatigue, nausea, vomiting, a fever on and off, and a rash on the trunk, abdomen, and face. Two people, including one who died, had risk factors for melioidosis, including chronic obstructive pulmonary disease (COPD) and cirrhosis, The other two had no known risk factors.

Melioidosis is usually found in subtropical and tropical areas, but none of the patients had traveled internationally, and CDC has yet to identify the source. Analysis of the bacterial strains suggests the patients may have been infected from the same source. They appear related to strains found in Asia.

"Currently, CDC believes the most likely cause is an imported product (such as a food or drink, personal care or cleaning products, or medicine) or an ingredient in one of those products," the agency said in a statement dated August 9.

Melioidosis isn't an infection most people in the US are familiar with, and with good reason. "It is very rare in the US," Richard Watkins, MD, an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University, told Health in July.

Here's what you need to know about this serious infection.

What is melioidosis, exactly?

Melioidosis, also known as Whitmore's disease, is an infectious disease that can infect humans or animals, the CDC explains. While melioidosis is more common in tropical climates, it's found most often in Southeast Asia and northern Australia.

What causes melioidosis?

Melioidosis is caused by the bacterium Burkholderia pseudomallei, which can be found in contaminated water and soil. The bacteria is spread to people and animals through direct contact with a contaminated source, the CDC says.

It's thought that people get the infection by inhaling contaminated dust or water droplets, drinking contaminated water, eating food that's been in contaminated soil, or coming into direct contact with contaminated soil, especially through cuts or scrapes.

"The vast majority of cases in the United States are in individuals who travel to areas where this infection is common," infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, previously told Health.

The four US cases are unusual, says CDC, because they hadn't traveled outside the continental US.

What are the symptoms of melioidosis?

There are different types of melioidosis infections, and each has their own set of symptoms. The CDC breaks them down this way:

Localized infection

• Localized pain or swelling
• Fever
• Ulceration
• Abscess

Pulmonary (chest) infection

• Cough
• Chest pain
• High fever
• Headache
• Anorexia

Bloodstream infection

• Fever
• Headache
• Respiratory distress
• Abdominal discomfort
• Joint pain
• Disorientation

Disseminated (widespread) infection

• Fever
• Weight loss
• Stomach or chest pain
• Muscle or joint pain
• Headache
• Central nervous system/brain infection
• Seizures

How is melioidosis treated?

Melioidosis treatment usually starts with an IV antimicrobial infusion that lasts for a minimum of two weeks, the CDC says. And if the infection is severe, the IV medication may be needed for up to eight weeks. After that, patients will be given three to six months of an oral antimicrobial medication to help them recover.

Who is at risk for melioidosis?

Technically, anyone can get the infection, the CDC says. But there are a few factors that increase your risk, including having one of the following underlying conditions:

• Diabetes
• Liver disease
• Renal disease
• Thalassemia
• Cancer or another immune-suppressing condition not related to HIV
• Chronic lung disease

How concerned about this should people be?

Dr. Adalja told Health in July that the general public shouldn't worry about this. But, he adds, "it is important [for health officials] to understand what their ultimate source is." Why? "Melioidosis is also an important agent in biological warfare/bioterrorism, so all cases outside of endemic region require thorough investigation," Dr. Adalja said. "It's also important to understand if any of the involved persons were connected to any lab working with the bacteria where a biosafety lapse may have occurred," he added.

How to prevent melioidosis

In areas where melioidosis is common (aka not the US), it's recommended that people wear protective clothes like shoes and gloves when they're exposed to soil or water, like when they're gardening. "Also, it can inhaled during monsoon season, so it is important to take precautions if outside during the rain where bacteria may be kicked up in endemic areas," Dr. Adalja said.

The CDC also recommends that healthcare workers use standard precautions when treating people with melioidosis to help prevent infection to protect themselves.

Again, melioidosis is rare in the US, but it does happen. "If you develop symptoms of melioidosis, especially after contact with water or soil, you should seek medical care right away," Dr. Watkins said.

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