Glanders (a highly communicable disease of horses, mules, and donkeys) rarely infects humans with sporadic reports in Africa, Asia, the Middle East, and Latin America. Patients have ulcerating nodules with lymphangitis and lymphadenopathy. In the pulmonary form, patients have fever and pleurisy.
CASES/YEAR
1 (US); 1,000 (Global)
OTHER NAMES
Burkholderia mallei infection;
INCUBATION
Up to a few months; 1-2 days (inhalation); Latent foci can reactivate years after exposure; [Cecil, 24th Ed, p. 1881]
INITIAL SYMPTOMS
INHALATION: Fever & tracheobronchitis; Mucopurulent discharge from nose, lips & eyes; Pneumonia; Neck & mediastinal lymphadenopathy; Pustular skin lesions; Septicemia; SKIN EXPOSURE: Suppurative skin nodules & regional lymphadenopathy; [PPID, p. 2715]
COMMENTS
FINDINGS:
Localized skin infections after direct inoculation consist of ulcerating nodules with lymphangitis and lymphadenopathy. In the pulmonary form, patients have fever and pleurisy. The chest x-ray may show diffuse infiltrates, nodular densities, or lobar consolidation. The septicemic form may follow untreated lymph node infections to seed abscesses of the skin, liver, spleen, and lungs. [ID, p. 1463-4] The disease occurs in both acute and chronic forms. Findings include papules, pustules, suppurating lymph nodes, adenopathy (neck & mediastinal), abscesses (liver, lung, spleen & skin), pneumonia, and septicemia. CNS infections may occur. [PPID, p. 2715] Causes tracheobronchial necrosis; Untreated infection is fatal within 10-14 days. [Cecil, 24th Ed, p. 1881] Direct inoculation into the eye can cause Parinaud's oculoglandular conjunctivitis. [Guerrant, p. 1005] Findings after inhalation exposure include fatigue, myalgias, pharyngitis, cough, chest pain, and cavitary lung disease. Osteomyelitis, brain abscesses, and meningitis are complications of endemic infections. [USAMRIID, p. 69-71]
EPIDEMIOLOGY:
This highly communicable disease of horses, mules, and donkeys rarely infects humans. Occupational infections occur in workers exposed to infected animals or laboratory cultures. [CCDM, p. 398] Humans become infected after contact with respiratory secretions and wound discharges from infected animals. Person-to-person transmission is possible. Only one case has been reported in the USA since 1944, and this was a worker in a biodefense laboratory. [ID, p. 1462] B. mallei bacteria live in equine hosts, not in the environment. [Harrison ID, p. 564]
DIAGNOSTIC
Culture; Serology (indistinguishable from melioidosis); [CCDM, p. 398]
SCOPE
Enzootic foci in Asia and eastern Mediterranean countries; [CCDM, p. 399] Asia, Africa, and South America; [ID, p. 1463]
SIGNS & SYMPTOMS
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>fatigue, weakness
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>fever
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>myalgia
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E nasal ulcers
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E pharyngitis
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E stomatitis
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H leukocytosis
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H leukopenia
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H lymphadenopathy
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N headache
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O conjunctivitis, acute
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O oculoglandular syndrome
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R chest pain
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R cough
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S entry wound with lymph nodes
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S lymphadenitis, acute
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S lymphangitis
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S nodular lymphangitis
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S papules or plaques
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S pustule
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S rash (exanthem)
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S skin or subcutaneous nodule
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S ulcer of skin
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X cystic or cavitary lesions
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X lung infiltrates
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X pleural effusions
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*brain abscess or lesion
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*mediastinitis
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*meningitis
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*osteomyelitis
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*pneumonia
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*sepsis
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*shock
ENTRY
Inhalation, Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Person-to-Person, Animal Excreta, Animal Tissue
RISK FACTORS
- Handle animal carcasses or placentas
- Travel to endemic area
- Victim--air release of infectious agents
- Work in a medical or research lab
REFERENCES FOR CASES/YEAR
1. (US) 1 case occurred in a laboratory worker in 2000. [CDC website]
2. (Global) Rare infectious disease; Eradicated from UK in 1928; [Public Health England website] Glanders is still present in Africa, Asia, and South America. It was eradicated from Europe and North America decades ago. [Harrison ID, p. 536] Guesstimate: 1000 cases/year;