ABSTRACT
Melioidosis, caused by Burkholderia pseudomallei, is a rare but potentially fatal bacterial disease endemic to tropical and subtropical regions worldwide. It is typically acquired through contact with contaminated soil or fresh water. Before this investigation, B. pseudomallei was not known to have been isolated from the environment in the continental United States. Here, we report on three patients living in the same Mississippi Gulf Coast county who presented with melioidosis within a 3-year period. They were infected by the same Western Hemisphere B. pseudomallei strain that was discovered in three environmental samples collected from the property of one of the patients. These findings indicate local acquisition of melioidosis from the environment in the Mississippi Gulf Coast region.
Subject(s)
Burkholderia pseudomallei , Environmental Microbiology , Melioidosis , Humans , Burkholderia pseudomallei/genetics , Burkholderia pseudomallei/isolation & purification , Melioidosis/epidemiology , Melioidosis/microbiology , United States/epidemiologyABSTRACT
OBJECTIVE: Between December 2005 and November 2007, a cluster of 11 tuberculosis (TB) cases emerged in Jackson County, Mississippi. We investigated the potential sources of disease transmission and epidemiologic links in this cluster to prevent future transmission in the community. MATERIALS AND METHODS: Cases of TB reported in Jackson County from December 2005 to November 2007 having matching genotypes or social links to patients with matching genotypes were included in the investigation. We interviewed patients, reviewed medical records, and performed contact investigations. RESULTS: The combined genotyping and epidemiologic data pointed to ongoing TB transmission in this rural community. A combination of patient-specific and programmatic factors, including substance use, delays in TB diagnosis, nonadherence, and TB program staffing cuts, contributed to this outbreak in the context of the 2004 and 2005 Atlantic hurricane seasons. CONCLUSIONS: To eliminate Mycobacterium tuberculosis transmission in this setting, recommendations for the TB program include enhanced coordination with substance abuse programs, community and provider education, and increased outreach capacity.