Recalled Air Freshener Spray Causes Melioidosis

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What do donkeys and air fresheners have in common? The answer lies in a family of bacteria called Burkholderiacae. These bacteria grow and flourish in soil and water and are most often found in tropical climates. When animals drink water contaminated with certain Burkholderia bacteria, an infection called “glanders” can occur. Glanders is a disease that primarily affects horses, mules, and donkeys. It is caused by the bacteria Burkholderia mallei, and affected animals develop fevers, weight loss, and lesions on their internal organs. Glanders is rarely seen in humans, although it has been reported to occur in laboratory workers and those who have close contact with infected animals. In humans, infection with glanders is characterized by fevers, pneumonia, and skin abscesses that result in widespread infection and sepsis. Even though glanders can be treated with antibiotics, death can occur in more than half of infected patients.

Because glanders can occur after exposure to very small numbers of Burkholderia mallei, this highly infectious bacteria has been explored as a biological warfare agent. Burkholderia mallei is reported to have been used in World Wars I and II, as well as the Russian invasion of Afghanistan. Currently, the United States Centers for Disease Control (CDC) classifies Burkholderia mallei as a potential bioterrorism agent.

Another Burkholderia bacteria, Burkholderia pseudomallei, can cause an infection called “melioidosis” in humans as well as animals. Melioidosis is a significant infectious concern in Australia and southeast Asia; in northern Thailand, melioidosis is the third most common cause of death from infectious disease. This condition has also been diagnosed in the United States in individuals who have traveled to endemic areas and had contact with infected soil or water. In humans, melioidosis occurs after individuals swallow or inhale contaminated water, and the bacteria can also pass through open wounds or cuts on the skin. Signs and symptoms of infection generally occur within 3 weeks of exposure to the bacteria and can include pneumonia, skin infections, and sepsis. Melioidosis can occur in adults as well as children and can be transmitted through breast milk from a mother to her infant. Although melioidosis can occur in healthy individuals, most patients infected with the disease have other underlying medical conditions, including diabetes, kidney disease, and alcoholism. Since melioidosis is not frequently encountered in the United States, it can be a challenging condition to diagnose. Fortunately, melioidosis can be treated with antibiotics, although delays in diagnosis are common and can result in a poorer overall outcome.

Recently, four cases of melioidosis were diagnosed in the United States. The affected patients included both children and adults. The patients had no history of recent international travel, although 3 of the 4 patients had underlying medical conditions including chronic obstructive pulmonary disease (COPD), cirrhosis, and COVID-19 infection. A CDC investigation found the presence of Burkholderia pseudomallei bacteria in a bottle of air freshener spray in one of the patients’ homes. The air freshener spray was labeled “Better Homes & Gardens Lavender & Chamomile Essential Oil Infused Aromatherapy Room Spray with Gemstones”. This spray was manufactured in India, imported into the United States, and sold at Walmart in stores and online. On October 22, 2021, a recall was issued for the several varieties of the Better Homes & Gardens air freshener spray. People who purchased the air freshener spray were advised to stop using the product and thoroughly wash all linens or surfaces that the product may have been sprayed onto.

For questions about toxic exposures to air fresheners, get help online with webPOISONCONTROL or call 1-800-222-1222. Both options are free for the public, and available 24 hours a day.

Kelly Johnson-Arbor, MD
Medical Toxicologist