Glanders

Aka: Glanders

1. Cause
   1. Burkholderia mallei (Malleomyces mallei)
      1. Formerly categorized as Pseudomonas
2. Pathophysiology
   1. Gram Negative bacillus
   2. Previously only domesticated animal infection
      1. Horses, Mules, and Donkeys
      2. Historically contracted by animal handlers (rare)
      3. No naturally acquired human cases in last 60 years
   3. Aerosolized risk as a biological warfare agent
      1. Infection rate in those exposed to aerosol: 46%
   4. Incubation: 10-14 days after inhalation
3. Symptoms (Septicemic form)
   1. Fever
   2. Rigors
   3. Night Sweats
   4. Myalgia
   5. Headache
   6. Pleuritic Chest Pain
   7. Photophobia
   8. Lacrimation
   9. Diarrhea
4. Signs
   1. Acute (Septicemic form)
      1. Fever
      2. Cervical adenopathy
      3. Splenomegaly
      4. Rash
         1. Generalized papular or pustular eruptions
   2. Chronic form
      1. Rash
         1. Cutaneous and intramuscular abscess
      2. Nasal Discharge and ulceration (50%)
5. Labs
   1. Exudate Methylene blue stain
      1. Scant small bacilli
   2. Sputum Culture on meat nutrient mediums
   3. Complete Blood Count
      1. Mild Leukocytosis with Left Shift
6. Radiology: Chest XRay
   1. Miliary Nodules (0.5 - 1.0 cm)
      1. Small, multiple Lung Abscesses
   2. Bronchopneumonia
   3. Lobar Pneumonia
   4. Necrotizing nodular lesions
7. Course
   1. Uniformly fatal if untreated
8. Complications
   1. Osteomyelitis
   2. Brain Abscess
   3. Meningitis
9. Prevention
   1. No Vaccine
   2. Post-exposure Prophylaxis with Septra
   3. Environmental Decontamination with 0.5% Hypochlorite
10. References
    1. (1998) Medical Management of Biological Casualties
       1. U.S. Army Medical Research Institute of ID