• A dangerous bacterium that can cause lung failure may now be found in the US
• The infection is called melioidosis and was previously contracted only in countries outside America
• Because there’s no vaccine, and the disease doesn’t respond to most antibiotics, it’s often fatal

Potentially deadly antibiotic-resistant bacteria could be hiding in the dirt and water of the southernmost US states, warns a new report from the US Centers for Disease Control and Prevention.

The bacterial infection, called melioidosis, caused the lungs of a 63-year-old Texan to shut down in late 2018, forcing doctors to put him on a ventilator to save his life, the researchers said.

US citizens who’ve caught melioidosis in the past typically picked it up in a foreign country, but this man had not recently travelled abroad, said Johanna Salzer, a veterinary medical officer with the CDC’s Bacterial Special Pathogens Branch.

What’s more, the bacteria that caused the man’s melioidosis were genetically similar to two prior US cases, one in Texas in 2004 and one in Arizona in 1999.

Resistant to many antibiotics

“We feel like this is evidence that it could be in the environment” in the United States, Salzer said. “We just need to find it.”

Melioidosis is caused by the bacteria Burkholderia pseudomallei. Humans pick up the bacteria by inhaling dust or tiny droplets of water, or by dirt or water getting into an open wound, Salzer said.

There are an estimated 160 000 cases of melioidosis every year around the world, and 89 000 deaths, “which is really high for a disease a lot of people don’t know about,” Salzer said. It most commonly kills through blood poisoning or respiratory failure.

The fatality rate is estimated to exceed 70% if a person sick with melioidosis is left untreated, Salzer said.

There’s no vaccine for the bacterium, and it is naturally resistant to many commonly used antibiotics. These include penicillin, ampicillin, cephalosporins, gentamicin, tobramycin and streptomycin, the researchers said.

Patients often require at least two weeks of IV drugs followed by several months of oral antibiotics to wipe out the infection.

On antibiotics for three months

The man, from Atascosa County, Texas, went to the hospital in November 2018. He’d had fever, chest pain and shortness of breath for three days, according to the report in the June issue of the CDC journal Emerging Infectious Diseases.

Doctors diagnosed him with pneumonia, and a blood test revealed a B. pseudomallei infection. He subsequently developed a large ulcer on his chest.

Four days after admission to the hospital, the man stopped breathing and was put on a ventilator. He was transferred to another hospital, which switched him to an antibiotic that was more effective against the bacteria.

The patient left the hospital after three weeks, but remained on daily antibiotics for another three months, according to the report. The disease also injured his kidney, which required dialysis three times a week.

These bacteria are most commonly found in the tropical climates of Southeast Asia, South and Central America, and northern Australia. It also has been detected in two US territories, Puerto Rico and the US Virgin Islands, Salzer said.

Tough to diagnose

Previously, B. pseudomallei “has never been found in the environment in the continental United States,” Salzer said.

Unfortunately, the handful of cases cited by the researchers seem to indicate that the bacteria might have made a home for themselves in the southern United States.

“There is global modelling that the bacteria could survive, and survive well, in Texas and areas of Florida,” Salzer said.

The CDC plans to partner with academic institutions to search for the bacteria in the continental United States, in much the same way that it was uncovered in Puerto Rico and the Virgin Islands, Salzer said.

Melioidosis can be tough to diagnose, Salzer said.

“It’s been called the Great Mimicker or the Imitator Disease,” Salzer said. “If you’re not looking for it, it doesn’t have really clear and reliable symptoms in all people.”

Many have diabetes

Symptoms also can take months or years to develop, making it even more difficult for doctors to puzzle out their patient’s illness, the report added.

The CDC experts urge doctors to test for the presence of the bacteria in patients in the southwestern United States who:

• Have symptoms that seem to indicate pneumonia, blood infection, skin lesions or internal organ abscesses
• Have chronic diseases that put them at increased risk for dangerous infections, especially diabetes or kidney disease
• Don’t improve after treatment with commonly used antibiotics

More than 60% of melioidosis patients have diabetes, including the man in Texas, Salzer said.

Dr Robert Glatter is an emergency medicine physician with Lenox Hill Hospital in New York City. “Lack of an international travel history should not rule out a diagnosis of melioidosis. People who also travel to the southwest US are consequently at increased risk,” he said.

“Increased healthcare provider awareness and education regarding the geographical distribution of this disease along with risk factors and pitfalls for managing melioidosis can help reduce mortality,” Glatter added.

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• The findings show a strong link between mother and infant transmission.
• Researchers have found the virus in an at-term placenta, umbilical cord, the vagina and in breast milk.
• Claudio Fenizia, from the University of Milan said none of the infants born during the study period tested positive for Covid-19.

There is “strong evidence” that Covid-19-positive mothers can pass the virus on to their unborn infants, scientists said Thursday, in findings that could affect how pregnant women are shielded during the pandemic.

While there have been isolated cases of babies infected with the virus, the findings show the strongest link yet between mother and infant transmission.

Researchers in Italy studied 31 pregnant women hospitalised with Covid-19, and found the virus in an at-term placenta, umbilical cord, the vagina of one woman and in breast milk.

They also identified specific Covid-19 antibodies in the umbilical cords of several pregnant women as well as in milk specimens.

Claudio Fenizia, from the University of Milan and lead study author, said the findings “strongly suggest” that in-vitro transmission is possible.

“Given the number of infected people worldwide, the number of women that could be affected by this could be potentially very high,” he told AFP.

Fenizia stressed that none of the infants born during the study period tested positive for Covid-19.

“Although in utero transmission seems to be possible, it is too early to clearly assess the risk and potential consequences,” he said.

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The World Health Organisation said last month that new mothers infected with Covid-19 should continue breastfeeding.

“We know that children are at relatively low-risk of Covid-19, but are at high risk of numerous other diseases and conditions that breastfeeding prevents,” said WHO chief Tedros Adhanom Ghebreyesus.

Among other findings, the team identified a specific inflammatory response triggered by Covid-19 in the women’s placenta and umbilical cord blood plasma.

Fenizia said that the women studied were all in their third trimester, given the timeframe of Italy’s epidemic, adding that more research is currently under way among Covid-19-positive women in the early stages of pregnancy.

“Our study is aimed at raising awareness and inviting the scientific community to consider the pregnancy in positive women as an urgent topic to further characterise and dissect,” he said.

“I believe that promoting prevention is the safer advice we could possibly give right now for these patients”.

The study was released during a week-long International AIDS Conference, held online for the first time in its history due to the pandemic.

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