The illness is most commonly found in tropical regions, but these three people hadn't traveled outside of the continental US.

By Korin Miller
July 06, 2021

The 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. The person who died also had chronic obstructive pulmonary disease (COPD) and cirrhosis, and died 10 days after being hospitalized.

Analysis of the strains suggests the patients may have been infected from the same source, like an imported product or animal, but the source hasn't been properly identified yet, the CDC says.

person pulling vegetables from soil
Credit: PeopleImages / Getty Images

One of those patients is still in the hospital, while one has been discharged to a short-term care facility. While melioidosis is usually found in subtropical and tropical areas, none of the patients' families said they had traveled outside of the continental US.

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, tells Health.

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, M.D., senior scholar at the Johns Hopkins Center for Health Security, tells Health.

It's not entirely clear what's behind the latest cases, though, given that the patients 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

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 says 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 says. "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 adds.

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 says.

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 says.


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