Puerto Rico: Alert after four deaths from flood-related melioidosis
The Puerto Rico Department of Health issued an alert for melioidosis after six cases were reported between the end of July and beginning of November of this year, of which four resulted in the death of the people affected by the condition, caused by the bacteria Burkholderia pseudomallei.
This bacteria is endemic in Puerto Rico and is common in soil and water in tropical environments. It is transmitted to humans and animals during severe weather events, such as hurricanes and heavy rains, when floods drag germs from the soil to the surface.
The cases were recorded mainly in the eastern area of ​​Puerto Rico, with four cases in the Caguas region, one in the Fajardo region and one in the Metropolitan Region. Most of the cases were patients with diabetes, and one of them suffered from cancer.
As for the deceased, one corresponds to the age group of 60 to 69 years, two to the 70 to 79 and one of 90 years or older. One of these deaths was reported in August, two in September and the fourth, in November.
A risk factor that has been identified is that most of these cases present diabetes. It is important to know that, during rainy events or after rain, people who move barefoot outdoors are exposed to this bacteria, particularly those with wounds on their feet, which facilitates the infection process.
The fact that bacteria from the soil are dragged to the surface increases the risk of infection through contact with contaminated water from skin lesions, by drinking or inhaling contaminated water drops or by inhalation of dust from contaminated soil.
The Department of Health urged medical services to evaluate and strengthen their work plans to handle a potential increase in cases of this disease. Early diagnosis and treatment of melioidosis can minimize complications and deaths.
After evaluating the cases, the Department of Health decided to issue the notice so that doctors and hospitals are alert to recognize these cases, because it is not usual to see them, so if they present symptoms, a suspicion of melioidosis should be evaluated.
The Department of Health recalled that the National Meteorological Service reported consistent patterns of heavy rain and flooding in recent months, creating conditions for an increased risk of melioidosis cases.
According to the Centers for Disease Control and Prevention (CDC), In the United States, the bacteria that causes melioidosis has been identified in Mississippi, Puerto Rico, and the U.S. Virgin Islands.
Around a dozen cases are identified each year in the United States, mostly in travelers coming from places where the disease is widespread. Occasionally, patients with melioidosis in the United States have had no history of travel to areas where the disease is commonly found. In these cases, CDC often works with local health departments to try to discover how the person got melioidosis.
In 2022, an investigation by state partners and CDC discovered B. pseudomallei in the environment in the Gulf Coast region of Mississippi. This was the first time these bacteria were found in the continental United States.
In March through July 2021, CDC confirmed four linked cases, including two deaths, of melioidosis in patients from Georgia, Kansas, Minnesota, and Texas. These patients had no recent history of international travel to areas where they could have gotten sick with melioidosis.
Whole genome sequencing at CDC showed the strains of B. pseudomallei that sickened the patients closely matched each other, suggesting there was a common source of infection. The strain of bacteria that sickened the patients was similar to those found most often in South Asia. This led CDC to suspect that an imported product may have been involved in the patients' illnesses.
As part of the public health investigation into these illnesses, CDC tested blood samples from the patients, as well as soil, water, and consumer products from in and around their homes. A product found in one patient's home, Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones, was confirmed as the source of their infections.
While melioidosis infections have taken place all over the world, it's mostly found in Southeast Asia and northern Australia. For example, in Thailand, officials have reported 3,935 melioidosis cases and 127 deaths through mid-December this year.
The onset of meliodosis symptoms occurs between two to four weeks after exposure. Those who are at greater risk of developing the disease are people with diabetes, chronic liver disease, chronic kidney disease, thalassemia, cancer and a weakened immune system.
Similarly, people with chronic respiratory diseases, such as cystic fibrosis, chronic obstructive pulmonary disease, and bronchiectasis, as well as people who consume a lot of alcohol, are at higher risk.
Melioidosis presents a wide range of symptoms that can involve any organ. This variability complicates the diagnostic process.
Symptoms depend on the site of infection and other diseases may appear, from localized infections to septicemia. Melioidosis may present general symptoms, such as fever – often high and persistent –, fatigue or malaise, weight loss, and muscle or joint pain.
On the other hand, localized infection can cause pain, swelling, or redness at the site of infection, skin ulcers, or abscesses, occasionally with pus discharge.
Respiratory symptoms due to pneumonia may also occur, including high fever and chills, coughing – which may produce mucus or blood –, shortness of breath or difficulty breathing, chest pain, and severe cases may progress to respiratory distress.
As for sepsis, it may reflect high fever with chills, severe abdominal pain, lethargy or confusion, rapid heart rate and low blood pressure (signs of septic shock), and respiratory distress.
Disseminated disease may also occur. In these cases, some of the symptoms are the formation of abscesses in internal organs, such as the liver, spleen, or brain; multiple abscesses at distant sites in the body; jaundice (when the liver has been affected); and neurological symptoms, such as headache or confusion.
Early diagnosis and treatment are essential for preventing severe complications.