Death of two Americans by melioidosis – the ‘Vietnamese time bomb’ disease – linked to Indian aromatherapy spray sold in Walmart

Bacterium that causes the obscure disease melioidosis was found in the aromatherapy spray of one of the victims
Burkholderia pseudomallei, usually found in people working in South Asian paddy fields, is so powerful it is considered to have potential as a bioweapon

United States

Amrit Dhillon

Published: 10:30pm, 27 Oct 2021

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Two Americans died and two became seriously ill from an obscure disease known as the “Vietnamese time bomb” after being infected with a bacterium linked to an India-manufactured aromatherapy spray sold in Walmart.

The first infections of burkholderia pseudomallei were detected on August 9 by a laboratory of the US Centres for Disease Control and Prevention (CDC) in America. Technicians found it in the aromatherapy spray used in the home of a person in Georgia who became ill in July and later died of melioidosis, also known as Whitmore’s disease.

The rare disease, which usually afflicts people working in South Asian paddy fields or in coastal areas during the monsoon in India, gained notoriety during the Vietnam war for its ability to strike down veterans long after their return. The bacterium that causes it is also sometimes known as “the great mimicker” for its tendency to be mistaken for other infections, and it is so powerful it is considered to have potential as a bioweapon.

The genetic fingerprint of the bacteria found in the recent cases in the United States was similar to that of strains usually found in South Asia. But CDC staff were flummoxed as none of the four patients had travelled to any country in the region. It was only when it became known that the spray had been made in India that they connected the dots.

The spray in question was called “Essential Oil infused Aromatherapy Room Spray with Gemstones”. It was made by Flora Classique (registered in California) in India and sold in 55 Walmart stores. Walmart has since removed the spray, along with several other scents made by Flora Classique.

Melioidosis, also known as Whitmore’s disease, is sometimes found in people who work in paddy fields. Photo: EPA

The CDC has recommended that anyone who has this aromatherapy spray in their home should stop using it immediately and double bag the bottle in clean, clear zip-top bags and place it in a small cardboard box to be returned to a Walmart store.

Even identifying the disease was quite a feat as melioidosis is notoriously difficult for doctors to identify and it is thought to be under-diagnosed and under-reported in India.

The symptoms are often mistaken for the common flu, chest infections, tuberculosis, scrub typhus, or leptospirosis. Since the disease affects different organs in different people – the brain, liver, lungs or bones – doctors are thrown off track and people die undiagnosed. It takes a very experienced and sharp microbiologist to spot the bacterium in a Petri dish.

Melioidosis cases are most common in tropical and subtropical countries. America gets about a dozen cases every year, mainly among people who have returned from a country where the disease is endemic such as parts of South and Southeast Asia and northern Australia.

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In India few people have heard of it. The website of the National Centre for Disease Control, Directorate General of Health Services, says it is seasonal, with “75 to 85 per cent of cases occurring during the rainy season”. It is mainly found in rural areas in the coastal regions of south India – Tamil Nadu, Karnataka, and Kerala – and has a high fatality rate of 16-50 per cent.

Those most at risk for melioidosis are adventure travellers, ecotourists and workers in construction, rice farming, fishing, and forestry. Their contact with contaminated soil or water may expose them to the bacteria which can live for decades in this soil and water. Those working in paddy fields are the most vulnerable.

They can be working knee-deep in a paddy field and catch the bacteria when they touch the contaminated soil with their hands or feet, especially if they have small cuts in the skin. Or a strong gust of wind can blow the soil into their lungs. If they happen to have diabetes or other diseases like chronic kidney disease, or are on certain drugs, their level of risk rises. It is not transmitted person to person.

“Often a person carrying the bacterium stays asymptomatic for years – until an illness triggers a full-blown infection. This happened to American soldiers returning from the Vietnam war in the mid-20th century.

One veteran remained healthy for six years after his homecoming – until he caught the flu, opening the doors to B. pseudomallei. This phenomenon earned melioidosis the nickname ‘the Vietnamese time bomb’,” wrote Indian science writer Priyanka Pulla on The Wire website in 2017.

The National Centre for Disease Control’s website says that India sees about 52,500 cases annually, with 32,000 deaths. An Indian academic paper from 2014 spoke of an “upsurge in melioidosis cases in India in the recent past owing to a lack of awareness among Indian clinicians and microbiologists which leads to misdiagnosis”. Some researchers believe the real figure is much higher.

The same paper said that B. pseudomallei is considered to have potential in biological warfare and is “regarded as a potential bioterrorist weapon” listed by the CDC.

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Dr Arjun Dang, owner of Dang’s Labs in New Delhi, believes that with increased international travel, labs need to be equipped adequately.

“B. pseudomallei has been called the ‘great mimicker’ and identifying it is not straightforward. But recent advances in molecular diagnostics have improved the accurate identification of the bacterium,” he said.

Flora Classique’s affiliate in India is Ramesh Flowers, based in Tuticorn in Tamil Nadu, which makes the sprays.

Its website says it is “one of the largest manufacturers and exporters of home fragrance and home decor products in India since its inception in 1982”.

What remains a mystery is how the bacterium entered the spray. This Week in Asia spoke to Ramesh Flowers’ vice-president, Chandra Shekhar, but he said he was unable to provide an explanation until his company, which was in touch with the CDC, had finalised a press release.