On Monday, the Centers for Disease Control and Prevention (CDC) announced that it would investigate two deaths linked to a rare bacterial disease typically only found in warmer climates.

A new fatal case of melioidosis, commonly referred to as Whitmore’s disease, has been reported in Georgia, marking the second recent death from the bacterial disease and the fourth case overall. The other cases were reported in three different states; Texas, Kansas, and Minnesota. Through the use of genome sequencing, the CDC reported that the cases all “closely match each other, suggesting there is a common source for these cases.”

Two of the cases have resulted in deaths, while the other two patients have survived. As the Dallas Morning News reported, one of the patients was a four-year-old girl who has suffered brain damage from the disease after she spent weeks on a ventilator. Common symptoms of the disease include coughing, chest pain and labored breathing, high fever, sudden weight loss, vomiting, and prolonged fatigue.

None of the patients have traveled internationally, but the bacterial strains appear to be closely related to similar strains found in South Asia. “Currently, CDC 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 agency wrote in its statement. "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 added that it has proved difficult tracing the source of the disease, as the bacteria typically takes between two to three weeks before someone is sick from it. "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," the statement reads.