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.
Why has glanders
become a current issue?
Burkholderia mallei is an organism that is associated
with infections in laboratory workers because so very few organisms
are required to cause disease. The organism has been considered
as a potential agent for biological warfare and of biological
terrorism.
How common is
glanders?
The United States has not seen any naturally occurring cases
since the 1940s. However, it is still commonly seen among domestic
animals in Africa, Asia, the Middle East, and Central and South
America.
How is glanders
transmitted and who can get it?
Glanders is transmitted to humans by direct contact with infected
animals. The bacteria enter the body through the skin and through
mucosal surfaces of the eyes and nose. The sporadic cases have
been documented in veterinarians, horse caretakers, and laboratorians.
What are the
symptoms of glanders?
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.
Localized infections: 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.
Pulmonary infections: In
pulmonary infections, pneumonia, pulmonary abscesses, and pleural
effusion can occur. Chest X-rays will show localized infection
in the lobes of the lungs.
Bloodstream infections: Glanders
bloodstream infections are usually fatal within 7 to 10 days.
Chronic infections: The
chronic form of glanders involves multiple abscesses within
the muscles of the arms and legs or in the spleen or liver.
Where is glanders
usually found?
Geographically, the disease is endemic in Africa, Asia, the
Middle East, and Central and South America.
How is glanders
diagnosed?
The disease is diagnosed in the laboratory by isolating Burkholderia
mallei from blood, sputum, urine, or skin lesions. Serologic
assays are not available.
Can glanders
spread from person to person?
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.
Is there a way
to prevent infection?
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.
Is there a
treatment for glanders?
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.