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Glanders

Glanders is an infectious disease that is caused by the bacterium Burkholderia mallei. Glanders is primarily a disease affecting horses, but it also affects donkeys and mules and can be naturally contracted by goats, dogs, and cats. Human infection, although not seen in the United States since 1945, has occurred rarely and sporadically among laboratory workers and those in direct and prolonged contact with infected, domestic animals. The disease is still commonly seen among domestic animals in Africa, Asia, the Middle East, and Central and South America.

In humans, the disease typically manifests itself in the acute form leading to dead within a few weeks. The symptoms of glanders depend upon the route of infection with the organism. The types of infection include localized, pus-forming cutaneous infections, pulmonary infections, bloodstream infections, and chronic suppurative infections of the skin. Generalized symptoms of glanders include fever, muscle aches, chest pain, muscle tightness, and headache. Additional symptoms have included excessive tearing of the eyes, light sensitivity, and diarrhea.

If there is a cut or scratch in the skin, a localized infection with ulceration will develop within 1 to 5 days at the site where the bacteria entered the body. Swollen lymph nodes may also be apparent. Infections involving the mucous membranes in the eyes, nose, and respiratory tract will cause increased mucus production from the affected sites. In pulmonary infections, pneumonia, pulmonary abscesses, and pleural effusion can occur. Chest X-rays will show localized infection in the lobes of the lungs. Glanders bloodstream infections are usually fatal within 7 to 10 days. The chronic form of glanders involves multiple abscesses within the muscles of the arms and legs or in the spleen or liver.

Case-fatality rate is over 50% in human cases with traditional antibiotic treatment, though susceptibility data suggest newer antibiotics should be efficacious. If left untreated, the case-fatality rate reaches up to 95%. The glanders bacteria are considered possible bioterrorism agents because they can be made into aerosols that are easy to spread and, if breathed in, could cause severe disease.

In addition to animal exposure, cases of human-to-human transmission have been reported. These cases included two suggested cases of sexual transmission and several cases in family members who cared for the patients.

There is no vaccine available for glanders. In countries where glanders is endemic in animals, prevention of the disease in humans involves identification and elimination of the infection in the animal population. Within the health care setting, transmission can be prevented by using common blood and body fluid precautions.

Because human cases of glanders are rare, there is limited information about antibiotic treatment of the organism in humans. Sulfadiazine has been found to be an effective in experimental animals and in humans. Burkholderia mallei is usually sensitive to tetracyclines, ciprofloxacin, streptomycin, novobiocin, gentamicin, imipenem, ceftrazidime, and the sulfonamides. Resistance to chloramphenicol has been reported.