Glanders - Pulmonary
Glanders is typically an equine disease. It is transmitted to humans through direct contact with an infected horse, donkey, or mule. The bacteria enter through the skin or the mucosal surfaces of the eyes, nose, and mouth or through inhalation.
Glanders has been identified by the CDC as a Category B bioterrorism agent. Category B agents are the second highest priority and include those that are moderately easy to disseminate, result in moderate morbidity rates and low mortality rates, and require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance. In the event of a bioterrorism attack, glanders would most likely be aerosolized.
Infection can be localized to the mucous membranes (acute localized glanders) or skin (chronic glanders), or manifest in the pulmonary system (acute pulmonary) and it may begin as or progress to a septicemic form.
In acute localized glanders, also known as farcy, the bacteria enter through breaks in the skin or mucosal surfaces of the eyes, nose, and mouth and cause conjunctivitis and/or bloody discharge of mucus and pus from the nose.
Pulmonary glanders has an incubation period of 10 to 14 days and presents with a sudden onset of flu-like symptoms accompanied by fever, rigors, sweats, cough, chest pain, myalgias, lacrimation, diarrhea, photophobia, cervical adenopathy, splenomegaly and a widespread papular/pustular rash similar to smallpox. It quickly progresses to pneumonia and/or pulmonary abscesses. Chest x-ray is positive for miliary nodules, infiltrates and/or lung abscesses. Pulmonary glanders can occur as a result of septicemic spread from cutaneous disease followed by infection of lymph nodes and septicemia.
In chronic glanders, which has a delayed onset, cutaneous and intramuscular abscesses occur on the arms and legs. Splenic and liver abscesses may be seen as well as enlarged regional lymph nodes. On rare occasions, it progresses to meningitis.
Without treatment, any of the acute forms have a mortality rate of up to 95%. The overall mortality rate of all forms, even with treatment, is 40%. Septicemic glanders is typically fatal within 7 to 10 days.
Person-to-person transmission is possible, including sexual transmission. A prophylactic treatment for glanders is available. People at risk include veterinarians, equine pet owners, abattoir workers, workers in laboratories where the organism is being handled, and travelers to endemic areas.
A24.0 – Glanders
4639008 – Glanders