10/25/2021: Lab Alert: Clinical Laboratory Burkholderia pseudomallei Notification

CDC's Laboratory Outreach Communication System (LOCS)

Audience: Clinical Laboratory Professionals

Level: Laboratory Alert

This Lab Alert is an update to the previous Lab Alerts issued on August 10, 2021 and July 1, 2021. Testing at the Centers for Disease Control and Prevention (CDC) has identified the bacterial DNA of Burkholderia pseudomallei in an aromatherapy room spray used in the home of the Georgia resident who was infected with and died from Burkholderia pseudomallei (B. pseudomallei) infection (melioidosis) in July 2021.

This Georgia patient was the fourth melioidosis case since March 2021 that involved three other patients in Kansas, Minnesota, and Texas, as described previously in the health alert notification (HAN) that CDC issued on August 9, 2021.

The contaminated product identified by a 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 and sold at Walmart between February and October 21, 2021. CDC is coordinating with state 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. CDC has also issued a HAN to inform physicians about this situation and provide recommendations.

What Laboratories Should Know:

  • Culture-based identification methods of B. pseudomallei from any clinical specimen are considered diagnostic for melioidosis. Ideal specimens for culture include blood, urine, throat swab, and, when relevant, respiratory specimens, abscesses, or wound swabs.
  • Laboratory testing involving automated identification algorithms (i.e., MALDI-TOF, 16s, VITEK-2) may misidentify B. pseudomallei as another bacterium. Misidentifications may include Burkholderia spp. (specifically B. cepacia and B. thailandensis), Chromobacterium violaceum, Ochrobactrum anthropi, and often Pseudomonas spp., Acinetobacter spp., and Aeromonas spp.
  • If B. pseudomallei is identified or an organism is suspected to be B. pseudomallei, contact your state or local public health laboratory or Laboratory Response Network (LRN) Reference Laboratory immediately.

Because cultures may grow B. pseudomallei, laboratory personnel should observe appropriate laboratory safety precautions to minimize laboratory exposure. These include:

  • Specimens suspected of containing Burkholderia pseudomallei should be clearly labeled as “suspected Burkholderia pseudomallei.
  • BSL-2 best practices, containment, and facilities specific requirements should be used when working with clinical specimens suspected of containing B. pseudomallei.
  • Perform all specimen manipulations within a certified Class II (or higher) Biosafety Cabinet (BSC).
  • When manipulating suspect cultures, BSL-3 best practices, containment equipment, and facilities requirements are recommended.
  • Burkholderia pseudomallei is a Tier 1 Select Agent and regulated by the Federal Select Agent Program.

For additional information on Burkholderia pseudomallei, refer to the American Society for Microbiology Sentinel Level Clinical Laboratory Guidelines.

Any questions or comments regarding this message should be directed to your state or local public health laboratory.

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Thank you,

The Laboratory Outreach Communication System

Laboratory Outreach Communication System (LOCS) | Division of Laboratory Systems (DLS)

Center for Surveillance, Epidemiology, and Laboratory Services (CSELS)

Centers for Disease Control and Prevention (CDC)