Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray

N Engl J Med. 2022 Mar 3;386(9):861-868. doi: 10.1056/NEJMoa2116130.


Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an uncommon infection that is typically associated with exposure to soil and water in tropical and subtropical environments. It is rarely diagnosed in the continental United States. Patients with melioidosis in the United States commonly report travel to regions where melioidosis is endemic. We report a cluster of four non-travel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas. These cases were caused by the same strain of B. pseudomallei that was linked to an aromatherapy spray product imported from a melioidosis-endemic area.

Publication types

  • Case Reports

MeSH terms

  • Aerosols
  • Aromatherapy / adverse effects*
  • Brain / microbiology
  • Brain / pathology
  • Burkholderia pseudomallei / genetics
  • Burkholderia pseudomallei / isolation & purification*
  • COVID-19 / complications
  • Child, Preschool
  • Disease Outbreaks*
  • Fatal Outcome
  • Female
  • Genome, Bacterial
  • Humans
  • Lung / microbiology
  • Lung / pathology
  • Male
  • Melioidosis / complications
  • Melioidosis / epidemiology*
  • Middle Aged
  • Phylogeny
  • Shock, Septic / microbiology
  • United States / epidemiology


  • Aerosols