A rare foreign bacteria in a scented room spray? It nearly killed a Texas girl.

A scented room spray.

It never occurred to Lylah Baker’s family that a seemingly innocuous product sold by one of the world’s largest retailers would be capable of delivering a deadly foreign bacteria directly into one of their Texas homes.

Yet on Tuesday evening, disease detectives at the Centers for Disease Control and Prevention announced that genetic tests confirmed that Better Homes & Gardens “Lavender & Chamomile with Gemstones” aromatherapy spray or one of its ingredients caused a highly unusual outbreak of infections this year in Lylah and three others who lived in Georgia, Kansas and Minnesota.

Two of these other patients died.

The CDC’s announcement came nearly five months after Lylah was hospitalized in Dallas with a raging infection that spread to her brain with devastating consequences, and hours after the little girl spent part of her 5th birthday going to physical therapy to try to regain her ability to walk and talk.

“You never expect a room spray,” Lylah’s aunt Ashley Kennon, who is a nurse and is serving as the family’s spokesperson, said as we spoke by phone Tuesday night. “It’s just crazy that this is what it’s linked to.”

'Doctors are still stunned': How did foreign bacteria leave a Texas girl with brain damage?

Kennon said one of Lylah’s grandmothers had been using the spray in her old home last spring before moving to a new home in early May. “She’s devastated,” Kennon said. “Not in a million years would we have thought it would be a product like that.”

Lylah and the three others were infected with a potentially deadly type of bacteria – called Burkholderia pseudomallei – that isn’t supposed to be found in the continental United States. These bacteria are primarily found in parts of Asia and Australia, where they thrive in wet, tropical environments. The bacteria cause a disease called melioidosis, which kills 10% to 50% of those who are sickened. Infections generally occur from people having direct contact with contaminated soil or water.

Walmart recalls room spray

What made this outbreak so unusual is that none of the four people who were sickened had traveled outside of the United States recently. And the bacteria causing each of their infections was not only the same strain, but also had a similar genetic fingerprint, indicating all of the patients had been exposed to a common product. The strain was one that appeared to be from South Asia, the CDC had said.

For months, the CDC and local health officials have been meeting with the victims and their families trying to find something they all had in common. It was a daunting task. Those sickened included both adults and children, and they lived in separate states.

The disease detectives used standardized lists of products and activities to quiz all of the families about any possible sources of exposure. They asked about a wide range of household items, including laundry detergent, bathroom cleaners, deodorizing sprays, nasal sprays, mouthwash, body wipes, essential oils, juices, fruit cups, tropical fish, garden soil and plants. Families provided boxes full of products to health officials for testing – and underwent sometimes multiple blood draws to assess how many family members had been exposed but not yet shown signs of illness.

'No clear answer': Few clues in case of girl sickened by foreign bacteria as others test positive

In a key breakthrough late last week, tests by the CDC discovered Burkholderia pseudomallei in a Better Homes & Gardens-branded lavender and chamomile aromatherapy room spray in the home of the Georgia person who died in July. Given the thousands of products consumers come into contact with, Inger Damon, director of CDC’s Division of High-Consequence Pathogens and Pathology, equated it to finding a needle in a haystack.

On Tuesday evening, the CDC announced that further DNA testing showed the bacteria in the scented spray had the same DNA fingerprint as the bacteria that infected the patients.

“This allows the CDC to confirm the spray or one of its ingredients caused the four melioidosis infections,” the agency said.

The spray, which was manufactured in India, was sold at Walmart between February and Oct. 21, the day before Walmart launched a recall of the product, as well as five other scents sold under the same Better Homes & Gardens brand name. About 3,900 bottles are being recalled.

CDC said consumers who have these sprays in their homes should stop using them immediately and contact their doctor if they have been exposed to the product or develop a fever or other symptoms. The agency stressed that they should not dump the contents of the product down the drain or throw the bottle in the trash because of the risk that this deadly bacteria could become established in U.S. soil and water and cause further infections. By returning the bottles to Walmart, consumers will receive a $20 gift card and ensure the contaminated product is disposed of safely.

Walmart recall: Aromatherapy room spray recalled after 2 deaths, 4 illnesses reported for rare bacteria risk

The sprays were made by Flora Classique Inc., a subsidiary of Gala Group, a company that bills itself as “one of the world’s leading and fastest-growing manufacturers of candles, home scents and home decor with around 5,000 employees and production sites in Europe, North America and India.”

Flora Classique CEO Gino Biondi said in an emailed statement Wednesday that the spray that has been implicated in the outbreak was manufactured at a facility operated by Ramesh Flowers in Tuticorin, India.

“Ramesh Flowers Private Limited and Flora Classique, Inc. are greatly concerned about the events leading to the recall,” Biondi and PS Suresh, CEO of Ramesh Flowers, said in the statement. “We have never had a safety issue of this type with any of our products in the past,” they said, and are cooperating with the CDC and the U.S. Consumer Product Safety Commission in their investigation.

Walmart spokesman Randy Hargrove said Flora Classique was the importer of record and had manufactured the aromatherapy spray as part of a small pilot project under the Better Homes & Garden brand name. The sprays were sold by Walmart online and at about 55 Walmart stores in 18 states.

In addition to CDC’s tests finding the bacteria being in the spray that was used in the home of the Georgia outbreak patient, federal investigators on Tuesday detected Burkholderia pseudomallei in another bottle of the spray from the same lot that was from the unsold inventory of a Walmart store in Beaver Dam, Wis. Additional testing of the Better Homes & Gardens spray line, including the other five scents, is still ongoing, the CDC said.

Walmart said it has been emailing customers who bought the products online. This week, after doing extensive research to identify contact information, the retailer emailed 2,000 customers who purchased the product at one of the 55 stores in the pilot project and is trying to reach hundreds of others through letters and calls.

The investigation continues

It’s still unclear exactly how people have been sickened by the room spray.

In guidance the CDC has sent out to health professionals, the agency indicated it’s likely that the infections occurred through nasal exposure or inhaling the contaminated spray. The agency has warned clinicians to consider people to have been potentially exposed to the bacteria if they had recently directly sniffed or inhaled the product, been in the room while the product was being sprayed, or had direct contact with an item such as a pillowcase or linens on which the product had been sprayed.

“At least two of the cases developed pneumonia, which is consistent with inhalation as the route of exposure,” the CDC said in an email to me.

In some high-risk cases, the CDC is recommending that people who have recently been exposed receive treatment with antibiotics to help prevent infection.

The source of this deadly outbreak raises larger, troubling questions about the potential for the contamination of other water-based products imported from countries where Burkholderia pseudomallei is endemic.

“On rare occasions in the past, imported products were suspected in cases in the U.S. But it was never proven even after sampling of items in the patients’ homes,” the CDC told me in a statement.

Recently, the CDC linked another U.S. melioidosis case to the person’s exposure to imported fish in a home freshwater aquarium.

“The increasing recognition of Burkholderia pseudomallei risks associated with imported products means physicians need to consider melioidosis in patients with symptoms of the illness, even if the patient doesn’t have a history of travel to an area where it is found,” the agency told me.

It's unclear whether regulatory mechanisms are in place or what agency is responsible for ensuring that other Burkholderia pseudomallei contaminated products – beyond this outbreak – aren’t being sold to U.S. consumers now or in the future.

"Very few cases involving bacteria in consumer products have risen to the level of a recall,” CPSC spokesperson Patty Davis told me. “If CDC identifies broader hazards with consumer products, we will follow up quickly as we did here.”

But the CDC isn’t a regulatory agency with the ability to mandate product testing by manufacturers. The CDC's disease detectives get involved after an outbreak is in progress and people have been sickened or died.

The CDC said it is continuing to investigate the ingredients in the implicated spray – including those sourced in the United States and those sourced in India – and is seeking to determine whether they may have been used in other products. The CDC added that various Better Homes & Gardens products come from many different manufacturers, and that the current recall affects only this specific line of aromatherapy products with gem stones, manufactured in India.

Damage has been done, family at risk

For Lylah and her family, knowing the source of the bacteria helps ease their fear that they all may have been continuing to be exposed to the bacteria. “Every time one of the kids have been sick since then, we’re thinking we really hope it’s not what Lylah had,” Kennon said.

Still, the damage has already been done to Lylah, and her family remains at some risk.

During the CDC investigation, tests found seven members of Lylah’s extended family have antibodies to Burkholderia pseudomallei, indicating they were exposed even if they weren’t obviously sickened. In rare cases, this type of bacteria can remain dormant in a person’s body for more than 20 years, before reactivating and causing disease.

Lylah continues to make slow and steady progress recovering from the brain damage caused by the bacteria, Kennon said. She goes to therapy three to four days a week and is able to move more of her upper body. While she’s still not talking, she is able to make more sounds. The family is grateful for support from throughout the community and from USA TODAY readers who have contributed thousands of dollars to Lylah’s GoFundMe fundraiser.

Before she got sick, Lylah had been looking forward to being a pee-wee cheerleader this fall for her cousins’ football team. Two weeks ago, she was able to wear the outfit and go out with the other cheerleaders. “It was probably the sweetest thing I have ever witnessed,” Kennon said. “She was so happy, and just to get to see her finally do something that all the other children were doing was amazing.”

To have the mystery finally solved on Lylah’s 5th birthday helps bring some closure. “I feel like she deserves that,” Kennon said.

But there is still a long road ahead.

Alison Young is an investigative reporter in Washington, D.C. She is also the Curtis B. Hurley Chair in Public Affairs Reporting at the Missouri School of Journalism. During 2009-19, she was a reporter and member of USA TODAY’s national investigative team. Follow her on Twitter: @alisonannyoung

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This article originally appeared on USA TODAY: Walmart recalls room spray with foreign bacteria that kills, injures