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.

Burkholderia mallei is an organism that is associated infrequently 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.

Geographically, the disease is endemic in Africa, Asia, the Middle East, and Central and South America.

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 radiographs 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.

Glanders is transmitted to humans by direct contact with infected animals. The bacteria enter the body through inoculation of or break in the skin and through mucosal surfaces of the eyes and nose. The sporadic cases have been documented in veterinarians, horse caretakers, and laboratory workers.

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.

Glanders may be used in bioterrorism. The most likely exposure would be through its use in a substance that would make direct contact with an individual, such as a powder.

The incubation period is highly variable, usually from 1 to 14 days. Manifestation of the disease can be delayed for up to 10 years.

The disease is diagnosed in the laboratory by isolating Burkholderia mallei from blood, sputum, urine, or skin lesions. Serologic assays are not available.

For sending specimens to the Central Public Health Laboratory, physicians must call 416-235-6100 during work hours and 416-605-3113 after work hours prior to submission.

Specimens should be handled according to universal precautions and packaged for transport to the Central Public Health Laboratory according to the Transportation of Dangerous Good regulation.

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.

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.

Although glanders is not a reportable disease in Ontario, it is requested that suspect cases be reported immediately to the public health branch by telephone (work hours 416-235-6100, off hours 416-605-3113).

Glanders is also a reportable animal disease in Canada and suspect animal cases should be reported to the Canadian Food Inspection Agency.

References

The information provided is subject to change. The information was collated from the following three sources :

1. Chin, J. "Control of Communicable Diseases Manual". 17th Edition. 2000. American Public Health Association: Washington D.C.
2. Health Canada website
3. Centers for Disease Control and Prevention website

*Advice on the most up-to-date treatment should be sought from a clinical expert.

January 2003