TUESDAY, Aug. 10, 2021 (HealthDay News) — The fourth U.S. case of the rare and potentially fatal bacterial disease melioidosis, typically found in the tropics, has been confirmed by the U.S. Centers for Disease Control and Prevention.

Genome testing shows that the strain in the latest case in Georgia is linked to the strains of Burkholderia pseudomallei bacteria that caused the three previous infections in Kansas, Texas, and Minnesota, suggesting a common source. Two of the four patients, including the one in Georgia, have died, the agency said in a statement Monday.

The cases are most closely related to strains found in Asia, particularly South Asia. However, none of the patients — which included adults and children — had traveled internationally, the CDC said. The agency has tested more than 100 samples of products, soil, and water in and around the patients’ homes, but none were positive for B. pseudomallei.

“While melioidosis is common in other parts of the world, it is exceedingly rare here in the United States,” said Teresa Murray Amato, M.D., chair of emergency medicine at Long Island Jewish in Forest Hills, New York. “Since none of the four traveled, it is most likely that they were exposed to either contaminated food or beverage products imported from that area.”

Pinpointing a single source of infection may prove difficult because the patients are in different states, their illnesses began at different times, and each could have been exposed to potentially hundreds of products before they became ill, according to the CDC.

The CDC is asking health care providers to be on the lookout for any acute bacterial infection that does not respond to normal antibiotics and to consider melioidosis, even if the patient has not traveled outside the United States. Health care providers are also urged not to rule out melioidosis as a possible diagnosis in children and people who were previously healthy and do not have known risk factors for melioidosis.

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