B. pseudomallei (Meliodidosis) Advisory for Healthcare Providers

Aromatherapy spray implicated in fatal B. pseudomallei (Meliodidosis) infection

Posted Oct. 27, 2021. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

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. This Georgia patient was the fourth melioidosis case in a cluster since March 2021 that involved three other patients in Kansas, Minnesota, and Texas, as described previously in an August 9 Health Advisory.

Based on genomic analysis, the four cases in Georgia, Kansas, Minnesota, and Texas in 2021 closely match, indicating they all most likely share a common source of exposure. None of these cases had a history of traveling outside of the continental United States. The four cases include both children and adults; two are female, and two are male. The first case, which was fatal, was identified in March 2021 in Kansas. The second and third cases, identified in May 2021 in Minnesota and Texas, were hospitalized for extended periods before being discharged to transitional care facilities.

The contaminated product identified by positive polymerase chain reaction (PCR) assay is the Better Homes and Gardens-branded Essential Oil Infused Aromatherapy Room Spray with Gemstones “Lavender & Chamomile” scent, manufactured in India. The spray was sold at Walmart between February and October 2021 and was distributed in a limited number of stores and online nationwide. This product was removed from stores and online marketplaces on October 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.

Recommendations for Consumers People who have the Better Homes & Gardens Aromatherapy Room Spray “Lavender & Chamomile” with Gemstones product, or any of the other recalled scents with Gemstones should take the following precautions:

  • 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 to the spray. If you do not have symptoms but were exposed to the product in the last 7 days, your doctor may recommend that you get antibiotics (post-exposure prophylaxis) to prevent infection.

Recommendations for Healthcare Providers

  • Maintain high clinical suspicion for melioidosis diagnosis in patients with an illness compatible with melioidosis with an exposure history in the past 21 days to Better Homes & Gardens Aromatherapy Room Spray “Lavender & Chamomile” with Gemstones or similar products.
  • Culture of B. pseudomallei from any clinical specimen is considered diagnostic for melioidosis. Recommended specimens for culture are guided by the clinical syndrome and include blood, sputum, urine, pus from skin and internal abscesses, joint aspirate, and cerebrospinal fluid. Throat swabs and rectal swabs inoculated into selective media increase diagnostic yield.
  • When ordering specimen cultures to diagnose melioidosis, advise the laboratory that cultures may grow B. pseudomallei, and that appropriate laboratory safety precautions should be followed by the laboratory personnel.
  • Consultation with infectious disease specialists is strongly recommended.
  • Offer postexposure prophylaxis (PEP) to patients who were exposed to this product within the past seven days.
  • Read the full alert from CDC for complete details and guidance for PEP, treatment and additional information.
  • Contact SRHD Epidemiology at 509-869-3133 if you have any questions or suspect a patient may be infected with Burkholderia pseudomallei.