Moreover, it has been a common pathogen isolated from troops of all nationalities that have served in areas with endemic disease. A few isolated cases of melioidosis have occurred in the Western Hemisphere in Mexico, Panama, Ecuador, Haiti, Brazil, Peru, Guyana, and in the states of Hawaii and Georgia. In the United States, confirmed cases range from none to five each year and occur among travelers and immigrants. Besides humans, many animal species are susceptible to melioidosis. These include sheep, goats, horses, swine, cattle, dogs, and cats.
Transmission occurs by direct contact with contaminated soil and surface waters.
In Southeast Asia, the organism has been repeatedly isolated from agriculture fields, with infection occurring primarily during the rainy season. Humans and animals are believed to acquire the infection by inhalation of dust, ingestion of contaminated water, and contact with contaminated soil especially through skin abrasions, and for military troops, by contamination of war wounds. There is one report of transmission to a sister with diabetes who was the caretaker for her brother who had chronic melioidosis. Two cases of sexual transmission have been reported. Transmission in both cases was preceded by a clinical history of chronic prostatitis in the source patient.