Glanders

Author: Dr Catriona Wootton, Consultant Dermatologist, UK. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Hamilton, New Zealand. April 2019. 


Introduction

Melioidosis and glanders are similar infections caused by the bacteria Burkholderia. They differ in geographical range and ecology.

See DermNet's page on melioidosis.

What is glanders?

Glanders is a rare, sporadic disease caused by the bacterium Burkholderia mallei (formerly Pseudomonas mallei, Actinobacillus mallei, Loefflerella malleiPfeifferella malleiMalleomyces malleiCorynebacterium malleiMycobacterium 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.

Who gets glanders?

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.

How is glanders acquired?

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.

What are the clinical features of glanders?

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

Localised infection is characterised by cutaneous inflammation with ulceration at the site of entry (a cut or scratch on the skin).

  • Lymphangitis (a red streak tracking to nearby lymph nodes) develops, and swollen lymph nodes or abscesses may also occur.
  • Infection involving the mucous membranes (eyes, nose, or respiratory tract) will result in excess mucous production at that site.
  • The nasal septum and palate may be destroyed by the infection.
  • Lymph nodes in the neck become enlarged, giving rise to the name glanders (from the French, glandre).
  • Fever, malaise and headache may occur 
  • Systemic infection may affect lungs, spleen, liver and other tissues.

Pulmonary infection

Glanders can result in pneumonia, lung abscesses, and pleural effusion due to direct inhalation or bloodborne spread. 

  • Symptoms are coughing, chest pain and shortness of breath.
  • There may be non-specific symptoms such as fever, headache, sweating and muscle pain.
  • Skin abscesses may develop several months after inhalation of the organisms.
  • If untreated, the pulmonary infection is likely to progress to septicaemia.

Bloodstream infection (septicaemia)

In septicaemia due to glanders:

  • Skin lesions – papules, pustules, blisters, ulcers and abscesses may occur
  • Multiple organ systems can be affected leading to abscesses and organ failure 
  • Death usually occurs within ten days.

Chronic infection

Multiple abscesses due to glanders may develop in the liver, spleen, lung, skin, or muscles.

  • The symptoms are less severe than described in acute infection.
  • Chronic infection is reported to persist for up to 25 years in some cases.

What are the complications of glanders?

Systemic infection may lead to multiple organ failure and death.

How is glanders diagnosed?

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.

Burkholderia mallei in culture

Image source PIXNIO.

What is the differential diagnosis for glanders?

The differential diagnoses for glanders includes any infectious disease causing fever, headache, muscle pain with pneumonia, abscesses or skin involvement, including:

What is the treatment for glanders?

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.

Prevention of glanders

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.

What is the outcome of glanders?

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.

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References

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