Melioidosis cases in Georgia, Minnesota, Texas, Kansas “most closely related to strains found in Asia, particularly South Asia”: What is the epi-link?

On Aug. 9, the U.S. Centers for Disease Control and Prevention reported both in their Health Alert Network and in a separate media statement a fourth case of melioidosis in the United States. This patient lived in Georgia and died in July 2021. The common exposure epidemiological (epi-) link that connects these four persons is still an enigma. That an epi-link does exist is suggested by the fact that CDC reported in the media statement that genomic analysis demonstrated that all four strains of the Burkholderia pseudomallei “appear most closely related to strains found in Asia, particularly South Asia, even though none of the patients traveled internationally.” Melioidosis is not usually considered contagious. Clinical laboratory workers should be advised if this bacteria is suspected, however, due to a risk of infection if it is aerosolized in the clinical laboratory. CDC “believes the most likely cause is an imported product” given that this bacteria has not been found in more than 100 samples tested from products, soil and water from inside and near the U.S. patients’ homes. The four states with one proven case between March and July are Kansas, Minnesota, Texas and Georgia. Two of the four patients have died. No autopsy results have been published so far, nor have antibiotic susceptibility profiles been reported to see if all four isolates are identical and to guide clinicians treating future patients in 2021. A review article on melioidosis in South Asia was published in June 2018 in Tropical Medicine Infectious Diseases by Mukhopadhyay and colleagues.

1. starting in all states with proven cases, such as by asking clinicians, clinical and reference laboratories and health departments to alert CDC to any unidentified gram-negative isolates or isolates any time in 2021 of the multiple bacteria that CDC lists in their HAN June 30 and Aug. 9 that can be misidentified as B. pseudomallei (e.g., B. thailandensis, B. cepacian, Chromabacterium violaceum, Ochronobactrum anthropi and possibly others).
2. of this typically multidrug-resistant bacteria and comparing with U.S. and global databanks of cases from South Asia AND cases imported from South Asia into, for example, the Middle East and elsewhere in 2020-2021.
3. to measure antibody levels against B. pseudomallei in the persons and geographic areas close to these four patients in four states (so far). It is not plausible to me that these are the only four patients with melioidosis in the U.S. in 2021. More exist and will be found in 2021 if the search is comprehensive.