II. Cause
- Burkholderia mallei (Malleomyces mallei)
- Formerly categorized as Pseudomonas
III. Pathophysiology
- Gram Negative bacillus
- Previously only domesticated animal infection
- Horses, Mules, and Donkeys
- Historically contracted by animal handlers (rare)
- No naturally acquired human cases in last 60 years
- Aerosolized risk as a biological warfare agent
- Infection rate in those exposed to aerosol: 46%
- Incubation: 10-14 days after inhalation
IV. Symptoms (Septicemic form)
- Fever
- Rigors
- Night Sweats
- Myalgia
- Headache
- Pleuritic Chest Pain
- Photophobia
- Lacrimation
- Diarrhea
V. Signs
- Acute (Septicemic form)
- Fever
- Cervical adenopathy
- Splenomegaly
- Rash
- Generalized papular or pustular eruptions
- Chronic form
- Rash
- Cutaneous and intramuscular abscess
- Nasal Discharge and ulceration (50%)
- Rash
VI. Labs
- Exudate Methylene blue stain
- Scant small bacilli
- Sputum Culture on meat nutrient mediums
-
Complete Blood Count
- Mild Leukocytosis with Left Shift
VII. Radiology: Chest XRay
-
Miliary Nodules (0.5 - 1.0 cm)
- Small, multiple Lung Abscesses
- Bronchopneumonia
- Lobar Pneumonia
- Necrotizing nodular lesions
VIII. Course
- Uniformly fatal if untreated
IX. Complications
X. Prevention
- No Vaccine
- Post-exposure Prophylaxis with Septra
- Environmental Decontamination with 0.5% Hypochlorite
XI. References
- (1998) Medical Management of Biological Casualties
- U.S. Army Medical Research Institute of ID