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glanders
Etiology:
- infection with Burkholderia mallei [1]
Epidemiology:
1) contact with infected
a) horses
b) mules
c) donkeys
2) endemic in Africa, Asia, the Middle East, Central & South America
3) eradicated from North America, Australia & most of Europe through surveillance & destruction of affected animals, & import restrictions
4) person to person transmission unlikely [5]
Clinical manifestations:
1) abrupt onset of symptoms
2) high fever/chills
3) myalgias
4) nausea/vomiting
5) lymphadenopathy
6) localized swelling
7) miliary lesions along lymphatic & subcutaneous tissues
8) disseminated granulomatous lesions
9) abscesses in skin & respiratory tract
10) chronic form with nasal & subcutaneous nodules that eventually ulcerate
Laboratory:
1) positive skin testing
2) positive complement fixation test
3) cultures
a) blood culture
b) sputum culture
c) culture exudates
4) complete blood count (CBC): leukocytosis
Radiology: chest X-ray
Complications:
- death can occur with days to months
- survivors can be carriers
Management:
1) in hospital treatment
a) isolation; barrier & secretion precautions
b) imipenem, ceftazidime, or meropenem plus either ciprofloxacin or doxycycline
c) intravenous therapy may last as long as 2-3 weeks followed by a switch to oral antibiotics (ciprofloxacin, doxycycline, TMP/SMX, or amoxicillin/clavulanate) for up to 150 days in order to prevent reactivation [5]
2) oral antibiotics (eradication)
a) amoxicillin clavulanate
b) doxycycline
c) Bactrim
d) alternative imipenem cilastin with or without Bactrim
3) for local disease with mild-moderate toxicity, use 2 of 3 antibiotics for 30 days, then switch to monotherapy for completion of 60-150 day course [5]
4) for extrapulmonary suppurative disease, 6-12 months of antibiotic therapy is recommended [5]
5) abscesses may need to be drained
6) no proven postexposure prophylaxis
7) no vaccine
8) reportable disease, contact local health department
Related
Burkholderia mallei (Malleomyces mallei)
melioidosis (Whitmore's disease)
General
bacterial infection
skin disease (dermatologic disorder, dermatopathy, dermatosis)
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 887
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 227
- Wikipedia: Glanders
http://en.wikipedia.org/wiki/Glanders
- Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/ glanders_g.htm
- eMedicine. Glanders and Melioidosis
http://www.emedicine.com/emerg/topic884.htm