Contaminated Ultrasound Gel Advisory for Healthcare Providers

Posted August 19, 2021. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

We have received two recent alerts from CDC’s Health Alert Network that we are sharing with you. Please distribute this information to the appropriate personnel in your facilities.

See these links for complete details and recommended actions.

• Health Advisory: Burkholderia cepacia Complex (Bcc) Infections Associated with Contaminated Ultrasound Gel--August 5, 2021
• CDC Health Update: New Case Identified: Multistate Investigation of Non-travel Associated Burkholderia pseudomallei Infections (Melioidosis) in Four Patients: Georgia, Kansas, Minnesota, and Texas—2021

1. Healthcare facilities should immediately stop use of all lots of Eco-Gel 200 ultrasound gel due to concern for bacterial contamination.
   • Review attached document for a list of specific lot numbers and brands, and additional recommendations
   • Identify and report cases of Burkholderia cepacia complex infections since 3/26/21 in persons who had ultrasonography within 2 weeks of onset of symptoms associated with the infection
2. Multi-state Investigation of Non-Travel Associated Melioidosis in Four Patients:
   The Georgia Department of Public Health, with assistance from the Centers for Disease Control and Prevention (CDC), is investigating a fatal case of Burkholderia pseudomallei infection (i.e., melioidosis) identified in late July 2021. Based on genomic analysis, this case in Georgia closely matches the three cases previously identified in Kansas, Minnesota, and Texas in 2021, indicating they all most likely share a common source of exposure. None of the cases had a history of traveling outside of the continental United States.
   • Symptoms of melioidosis are varied and nonspecific, and may include pneumonia, abscess formation, and blood infections. Due to its nonspecific symptoms, melioidosis can initially be mistaken for other diseases such as tuberculosis, which can delay proper treatment.
   • Consider melioidosis diagnosis in patients with a compatible illness, even if they do not have a travel history to a disease-endemic country. Please open and review attachment for additional information and recommendations.
   • Please open and review attachment for additional information and recommendations.