GLANDERS

Introduction

Glanders is a serious bacterial disease that mainly affects horses, donkeys and mules. Occasionally, the infection may spread to human beings, resulting in a potentially life-threatening condition. The causative organism has also been considered as a potential agent biological terrorism.

Alternative Names

• Farcy

• Malleus

Classification & Types

The organism causing glanders is classified under Proteobacteria. The complete classification is as follows:

• Kingdom: Bacteria
• Phylum: Proteobacteria
• Class: Beta Proteobacteria
• Order: Burkholderiales
• Family: Burkholderiaceae

Causes & Risk factors

Glanders results from infection by the bacterium Burkholderia mallei. Humans may be infected when they come in contact with sick animals or contaminated objects. Transmission of the bacterium generally occurs through small wounds and not through intact skin. Very occasionally, ingestion or inhalation of the bacterium may also result in infection among humans.

Symptoms & Signs
Generalized symptoms of glanders:

• Fever
• Myalgia
• Headache
• Chest pain
• Watery discharge from eyes
• Diarrhea
• Glanders may manifest in humans as one of the following types of infections:
• Localized infections:  a localized infection with ulceration may occur at the site of a cut.  In infection of eyes or nose, there may be increased discharge from the infected sites.
• Lung infections: Glanders may cause pneumonia or abscesses in the lungs.
• Septicemia: Glanders bloodstream infections can rapidly result in death in the absence of proper treatment
• Chronic infections: The chronic form of glanders is characterized by multiple abscesses in various organs.

Diagnosis

Confirmation of the diagnosis in a suspected case of glanders is based on by culturing B. mallei from lesions. This organism may also be found in sputum, urine or blood.

More recently, polymerase chain reaction (PCR) assays have been used to improve the sensitivity of lab tests. Chest X-ray is important in diagnosis of lung infection.

Prognosis

In the absence of treatment with effective antibiotics, the mortality rate for glanders can be as high as 95%, especially in the septicemic type. Even with treatment, up to 50% of the patients die.  Treatment with the newer antibiotics may improve the prognosis.

Case Studies

A 56 year old farmer presented with severe cough and fever for past five days. There was history of regular exposure to animals on the farm, some of which had fallen sick recently. This raised a suspicion of glanders, which was confirmed on culture of the sputum. The patient was admitted to ICU and started on antibiotics. The patient responded to antibiotic treatment and gradually improved over next few weeks. A screening of the entire family was also advised, along with proper treatment of all sick animals at his farm.

Treatment Options

Glanders is treated with antibiotics. Sensitivity testing on cultures of the causative organism may help choose the antibiotic best suited to a particular case. Sick patients may need to be admitted in intensive care units. Abscesses may be required to be drained.

References

• http://www.cdc.gov/glanders/
• Redfearn MS, Palleroni NJ: Glanders and melioidosis. In: Hubbert WT, McCulloch WF, Schnurrenberger PR, editors. Diseases transmitted from animals to man. 6th ed. Springfield, IL: Charles C. Thomas; 1975. p. 110-128. 
• http://www.oie.int/fileadmin/Home/eng/Health_standards/tahm/2.05.11_GLANDERS.pdf
• Kortepeter M, Christopher G, Cieslak T, Culpepper R, Darling R, Pavlin J, Rowe J, McKee K, Eitzen E, editors. Medical management of biological casualties’ handbook [online]. 4th ed. United States Department of Defense; 2001. Glanders and melioidosis.