Water and soil are the usual transmission sources when rare Burkholderia pseudomallei infections occur.

But in the latest CDC Health Update, the source of four recent associated Burkholderia pseudomallei Infections, also known as Melioidosis, was Gardens-branded Essential Oil infused Aromatherapy Room Spray with Gemstones  “Lavender & Chamomile” scent manufactured in India and sold at Walmart.

The killer room spray has caused one death in Georgia and three infections in Kansas, Minnesota, and Texas.

CDC first reported on the cluster of Burkholderia pseudomallei infections in the U.S. on Aug. 9, 2021. It made the following points in an Oct. 22 update:

• The spray was sold at Walmart between February and October 21, 2021, and was distributed in a limited number of stores and online nationwide. Whole genome sequencing results from the positive product sample are pending.
• This product was removed from stores and online marketplaces on Oct. 21, 2021, and out of abundance of caution, the five other scents under the same brand were removed from Walmart marketplaces as well (Lemon & Mandarin, Lavender, Peppermint, Lime & Eucalyptus, and Sandalwood & Vanilla). Testing will be conducted on these additional scents as well.
• Recalls are being initiated by the Consumer Product Safety Commission and Walmart.
• CDC is working with the Kansas Department of Health and Environment, the Texas Department of State Health Services, the Minnesota Department of Health, the Georgia Department of Public Health, and federal partners to learn whether the other patients used the implicated product and if other products need to be further investigated.
• This investigation and response are ongoing, and CDC will share more information as it becomes available.

“Testing at the Centers for Disease Control and Prevention (CDC) has identified the bacterial DNA of Burkholderia pseudomallei in an aromatherapy room spray in the home of the Georgia resident who was infected with and died from Burkholderia pseudomallei infection (melioidosis) in July 2021,” according to the update.

The updat further said: “Initial presentation for these four cases ranged from cough and shortness of breath to weakness, fatigue, nausea, vomiting, intermittent fever, and rash on the trunk, abdomen, and face. Two of the cases, one of them fatal, had several risk factors for melioidosis, including chronic obstructive pulmonary disease (COPD) and cirrhosis. The remaining cases had no known risk factors for melioidosis, though one case had a co-infection with SARS-CoV-2. Both pediatric cases had severe neurologic involvement”

Burkholderia pseudomallei, the causative agent of melioidosis, is a “Tier 1 selec agent” that can infect animals and humans, CDC reports. Cases are most common in areas of the world with tropical and sub-tropical climates. The approximately one dozen cases reported to CDC annually predominantly occur in people returning from a country wher the disease is endemic.

The updat cautions that Melioidosis is not considered to be transmitted person-to-person via air or respiratory droplets in non- laboratory settings.

“There have only been a few documented cases of person-to-person transmission. In disease-endemic areas, percutaneous inoculation is a common route for natural infection, ” CDC says.  “However, in the context of this cluster, the route of transmission is most likely intranasal or inhalation of the contaminated room spray. Healthcare personnel are generally not at risk if they follow standard precautions when working with infected patients. ”

CDC’s public reccomdations include:

• Stop using this product immediately. Do not open the bottle. Do not throw away or dispose of the bottle in the regular trash.
• Double bag the bottle in clean, clear zip-top bags and place in a cardboard box. Return the bagged and boxed product to a Walmart store.
• Wash sheets or linens that the product may have been sprayed on using normal laundry detergent and dry completely in a hot dryer; bleach can be used if desired.
• Wipe down counters and surfaces that might have the spray on them with undiluted PineSol or similar disinfectant.
• Limit direct handling of the spray bottle and wash hands thoroughly after touching the bottle or linens. If gloves were used, wash hands afterward.
• If you used the product within the past 21 days and develop a fever or other melioidosis symptoms, you should seek medical care and inform your doctor about your exposure.