Recalled Air Freshener Spray Causes Melioidosis

hand spraying air freshener in living room

The Bottom Line

Melioidosis is a serious infection caused by the bacteria Burkholderia pseudomallei. Humans can be exposed to the bacteria through contact with contaminated water or soil in tropical countries. In 2021, an outbreak of melioidosis occurred in the United States due to contaminated aromatherapy spray.

spray bottles and towels next to greenery

The Full Story

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

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • If you purchased Better Homes & Gardens Aromatherapy Room Spray with Gemstones, including the scents Lavender & Chamomile, Lemon & Mandarin, Lavender, Peppermint, Lime & Eucalyptus, or Sandalwood & Vanilla, stop using the product(s) immediately. Information about how to obtain a refund can be found here
  • If you were exposed to the recalled Better Homes & Gardens aromatherapy spray within the past 21 days and develop fever, coughing, or skin lesions, call your doctor and let him or her know that you were exposed to a product that has been recalled due to bacterial contamination with the potential to cause serious illness.
  • If you were exposed to the recalled Better Homes & Gardens aromatherapy spray within the past 7 days but do not have any symptoms, call your doctor, as you may be advised to take antibiotics to prevent melioidosis infection.
  • Wash your hands thoroughly after contact with potentially contaminated water or soil, as well as after petting or handling animals. 

This Really Happened

From March through July 2021, four cases of melioidosis were diagnosed in adults and children living in Georgia, Kansas, Minnesota, and Texas. None of the patients had traveled internationally, and genetic testing showed that the patients were all infected by a similar type of Burkholderia pseudomallei bacteria. Investigators from the CDC tested soil and water samples from the patient’s homes and detected the presence of Burkholderia pseudomallei in an aromatherapy spray that was found in the home of the Georgia patient. Further testing revealed that the same spray product likely caused the illness in the other three patients also. The United States Consumer Product Safety Commission issued a recall notice for the aromatherapy spray on October 22, 2021.

For More Information

CDC. 2021 multistate outbreak of melioidosis [accessed 10.27.21].

Fox, M. Mystery of exotic infectious disease traced to aromatherapy room spray. CNN. 2021 Oct 24.


References

Benoit TJ, Blaney DD, Doker TJ, Gee JE, Elrod MG, Rolim DB, Inglis TJ, Hoffmaster AR, Bower WA, Walke HT. A Review of Melioidosis Cases in the Americas. Am J Trop Med Hyg. 2015 Dec;93(6):1134-9. 

CDC. 2021 multistate outbreak of melioidosis [accessed 10.27.21].

CDC. Glanders [accessed 10.27.21].

Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev. 2005 Apr;18(2):383-416. 

Gassiep I, Armstrong M, Norton R. Human Melioidosis. Clin Microbiol Rev. 2020 Mar 11;33(2):e00006-19. 

United States Consumer Product Safety Commission. Walmart recalls Better Homes and Gardens essential oil infused aromatherapy room spray with gemstones due to rare and dangerous bacteria; two deaths investigated [accessed 10.27.21].

Van Zandt KE, Greer MT, Gelhaus HC. Glanders: an overview of infection in humans. Orphanet J Rare Dis. 2013 Sep 3;8:131. 

Virk HS, Mukhopadhyay C, Wiersinga WJ. Melioidosis: A Neglected Cause of Community-Acquired Pneumonia. Semin Respir Crit Care Med. 2020 Aug;41(4):496-508.

Whitlock GC, Estes DM, Torres AG. Glanders: off to the races with Burkholderia mallei. FEMS Microbiol Lett. 2007 Dec;277(2):115-22.

Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012 Sep 13;367(11):1035-44. 

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, Limmathurotsakul D. Melioidosis. Nat Rev Dis Primers. 2018 Feb 1;4:17107. 

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • If you purchased Better Homes & Gardens Aromatherapy Room Spray with Gemstones, including the scents Lavender & Chamomile, Lemon & Mandarin, Lavender, Peppermint, Lime & Eucalyptus, or Sandalwood & Vanilla, stop using the product(s) immediately. Information about how to obtain a refund can be found here
  • If you were exposed to the recalled Better Homes & Gardens aromatherapy spray within the past 21 days and develop fever, coughing, or skin lesions, call your doctor and let him or her know that you were exposed to a product that has been recalled due to bacterial contamination with the potential to cause serious illness.
  • If you were exposed to the recalled Better Homes & Gardens aromatherapy spray within the past 7 days but do not have any symptoms, call your doctor, as you may be advised to take antibiotics to prevent melioidosis infection.
  • Wash your hands thoroughly after contact with potentially contaminated water or soil, as well as after petting or handling animals. 

This Really Happened

From March through July 2021, four cases of melioidosis were diagnosed in adults and children living in Georgia, Kansas, Minnesota, and Texas. None of the patients had traveled internationally, and genetic testing showed that the patients were all infected by a similar type of Burkholderia pseudomallei bacteria. Investigators from the CDC tested soil and water samples from the patient’s homes and detected the presence of Burkholderia pseudomallei in an aromatherapy spray that was found in the home of the Georgia patient. Further testing revealed that the same spray product likely caused the illness in the other three patients also. The United States Consumer Product Safety Commission issued a recall notice for the aromatherapy spray on October 22, 2021.