Author: Dr Catriona Wootton, Consultant Dermatologist, UK. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Hamilton, New Zealand. April 2019.
Melioidosis and glanders are similar infections caused by the bacteria Burkholderia. They differ in geographical range and ecology.
See DermNet's page on melioidosis.
Glanders is a rare, sporadic disease caused by the bacterium Burkholderia mallei (formerly Pseudomonas mallei, Actinobacillus mallei, Loefflerella mallei, Pfeifferella mallei, Malleomyces mallei, Corynebacterium mallei, Mycobacterium mallei and Bacillus mallei). Glanders is primarily a disease of horses, although it may occur in other animals. It is uncommon now that horses are used less frequently for transport, but is sometimes seen in parts of Africa, Asia, the Middle East, and Central and South America. Infection with B. mallei may occur in people in direct contact with infected animals. The bacteria enter the body through abrasion of the skin or mucosal surfaces of the eyes, nose, and respiratory tract. Cases of person-to-person transmission have rarely been reported. It can prove fatal and is considered to be a potential biological warfare agent because it is highly infectious by inhalation.
Glanders is also known as farcy and maliasmas.
Anyone working closely with animals or tissue from infected animals, especially horses, is at risk of glanders: veterinarians, stable hands, laboratory workers, butchers and abattoir workers.
B. mallei is a host-adapted derivative of B. pseudomallei, the cause of melioidosis. B. mallei are spread to humans and animals via contact with infected animals, especially horses, through skin abrasions, mucous membranes or the inhalation of contaminated dust. Person-to-person transmission is rare.
The incubation period for glanders is around 1–14 days after infection. The clinical presentation will depend upon the mode of entry and is similar to melioidosis. Symptoms common to all forms include fever, sweating, muscle ache, chest pain and headache.
Localised infection is characterised by cutaneous inflammation with ulceration at the site of entry (a cut or scratch on the skin).
Glanders can result in pneumonia, lung abscesses, and pleural effusion due to direct inhalation or bloodborne spread.
In septicaemia due to glanders:
Multiple abscesses due to glanders may develop in the liver, spleen, lung, skin, or muscles.
Systemic infection may lead to multiple organ failure and death.
The diagnosis of glanders is confirmed by culture from blood, sputum or other infected sites.
Be sure to inform the laboratory of the suspected or confirmed diagnosis.
Image source PIXNIO.
The differential diagnoses for glanders includes any infectious disease causing fever, headache, muscle pain with pneumonia, abscesses or skin involvement, including:
As it is a bacterial infection, antibiotics are the mainstay of treatment for glanders. As the infection is rare in humans, there are currently no evidence-based treatment guidelines, but a similar approach to that recommended for melioidosis should be adopted.
No vaccine is currently available for glanders. Prevention involves identifying and eradicating infecting animals in endemic areas and appropriate use of personal protective equipment in the healthcare setting and those dealing with potentially infected animals.
Glanders carried a high fatality rate in the pre-antibiotic era, but there have been few human cases since the introduction of antibiotics. It is expected that it would behave similarly to melioidosis.
Spickler, Anna Rovid. Glanders. At http://www.cfsph.iastate.edu/DiseaseInfo/disease.php?name=glanders&lang=en. Accessed April 16, 2019.
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