title: Fatal Burkholderia pseudomallei infection initially reported as a Bacillus species, Ohio, 2013.
abstract: A fatal case of melioidosis was diagnosed in Ohio one month after culture results were initially reported as a Bacillus species. To identify a source of infection and assess risk in patient contacts, we abstracted patient charts; interviewed physicians and contacts; genetically characterized the isolate; performed a Burkholderia pseudomallei antibody indirect hemagglutination assay on household contacts and pets to assess seropositivity; and collected household plant, soil, liquid, and insect samples for culturing and real-time polymerase chain reaction testing. Family members and pets tested were seronegative for B. pseudomallei. Environmental samples were negative by real-time polymerase chain reaction and culture. Although the patient never traveled internationally, the isolate genotype was consistent with an isolate that originated in Southeast Asia. This investigation identified the fifth reported locally acquired non-laboratory melioidosis case in the contiguous United States. Physicians and laboratories should be aware of this potentially emerging disease and refer positive cultures to a Laboratory Response Network laboratory.
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio thomas.doker@gmail.com.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Doker
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Celia L
authors.initials: CL
authors.lastname: Quinn
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Salehi
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Sherwood
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Benoit
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Mindy
authors.initials: M
authors.lastname: Glass Elrod
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Jay E
authors.initials: JE
authors.lastname: Gee
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Sean V
authors.initials: SV
authors.lastname: Shadomy
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: William A
authors.initials: WA
authors.lastname: Bower
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Hoffmaster
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Walke
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: David D
authors.initials: DD
authors.lastname: Blaney
authors.affiliation: Epidemic Intelligence Service, and Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Department of Health, Columbus, Ohio; Pike County General Health District, Waverly, Ohio.
authors.forename: Mary S
authors.initials: MS
authors.lastname: DiOrio
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000276:immunology*; D001407:Bacillus / Q000302:isolation & purification; D016470:Bacteremia / Q000382:microbiology; D016957:Burkholderia pseudomallei / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D017809:Fatal Outcome; D006386:Hemagglutination Tests; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000175:diagnosis* / Q000382:microbiology; D009820:Ohio
chemical_list: D000907:Antibodies, Bacterial
references.citation: J Lab Clin Med. 1951 Sep;38(3):374-83
references.pmid: 14880750
references.citation: PLoS Negl Trop Dis. 2010 Nov 30;4(11):e900
references.pmid: 21152057
references.citation: Am J Dis Child. 1971 Nov;122(5):446-8
references.pmid: 5210136
references.citation: PLoS One. 2011;6(12):e29323
references.pmid: 22195045
references.citation: Ann Intern Med. 1975 Oct;83(4):512-3
references.pmid: 1174405
references.citation: J Clin Microbiol. 2005 Feb;43(2):970-2
references.pmid: 15695721
references.citation: Clin Infect Dis. 2000 Oct;31(4):981-6
references.pmid: 11049780
references.citation: Emerg Infect Dis. 2014 Feb;20(2):304-6
references.pmid: 24447394
references.citation: N Engl J Med. 2012 Sep 13;367(11):1035-44
references.pmid: 22970946
references.citation: Clin Vaccine Immunol. 2009 Jun;16(6):924-30
references.pmid: 19403784
references.citation: J Clin Microbiol. 2006 Jan;44(1):85-90
references.pmid: 16390953
references.citation: Appl Environ Microbiol. 2007 Nov;73(21):6891-7
references.pmid: 17873073
references.citation: Eur Respir J. 2003 Sep;22(3):542-50
references.pmid: 14516149
references.citation: J Clin Microbiol. 2003 May;41(5):2068-79
references.pmid: 12734250
references.citation: PLoS Negl Trop Dis. 2013;7(2):e2072
references.pmid: 23437412
references.citation: Emerg Infect Dis. 2011 Jul;17(7):1286-8
references.pmid: 21762589
references.citation: Am J Trop Med Hyg. 2006 Nov;75(5):947-54
references.pmid: 17123994
references.citation: Clin Microbiol Rev. 2005 Apr;18(2):383-416
references.pmid: 15831829
references.citation: Acta Trop. 2000 Feb 5;74(2-3):121-7
references.pmid: 10674639
references.citation: Appl Microbiol. 1970 Nov;20(5):825-33
references.pmid: 5530276
references.citation: J Appl Microbiol. 1997 May;82(5):589-96
references.pmid: 9172400
references.citation: Rev Inst Med Trop Sao Paulo. 2006 Jan-Feb;48(1):1-4
references.pmid: 16547571