The Centers for Disease Control and Prevention says a person from Georgia has died from a rare disease usually found in South Asia: Melioidosis.

The new death brings the total number of confirmed cases to four in different states. The cases have included adults and children. Two of the four patients had no known risk factors for melioidosis; two died.

None of the cases from Georgia, Kansas, Minnesota or Texas traveled internationally, puzzling experts.

The CDC said it believes the most likely cause is an imported product (such as a food or drink, personal care or cleaning products or medicine) or an ingredient in one of those types of products.

The bacteria normally lives in moist soil and water. However, in rare cases, it has also been found to contaminate wet or moist products in the areas where the bacteria are common.

The CDC said the diagnosis is challenging because unlike the germs that cause most foodborne outbreaks, the bacteria responsible for melioidosis can take two to three weeks to make someone sick. This expands the window of time that investigators need to explore and means people may be less likely to remember everything they were exposed to before becoming ill. Each patient could have been exposed to potentially hundreds of products before they became ill.

The CDC is asking clinicians to watch for any acute bacterial infection that doesn’t respond to normal antibiotics and consider melioidosis – regardless of whether the patient traveled outside the U.S. The CDC also urges clinicians not to rule out melioidosis as a possible diagnosis in children and those who were previously healthy and without known risk factors for melioidosis.

WSB