What are the other names for this Condition (Also known as/Synonyms)

• Farcy
• Malleus

What is Glanders? (Definition/Background Information)

• Glanders is an infectious disease of domestic animals, mainly horses and donkeys. The causative pathogenic bacterium is Burkholderia mallei that can also infect humans following exposure to the infected animals
• The disease is characterised by fever, muscle pain, cough, skin infection, shortness of breath, and formation of lung abscesses. The complications may include multiple organ damage, which can be fatal
• Antibiotic therapy is the mainstay of treatment. With correct diagnosis and appropriate treatment, the prognosis of Glanders can be favorable. However, if the infection is left unattended, it may lead to fatalities, especially from septicemia and organ failure

Who gets Glanders? (Age and Sex Distribution)

• Glanders can occur at any age and there is no gender predilection, meaning both males and females are affected
• Worldwide, individuals irrespective of race and ethnicity may be infected
• The condition is mostly prevalent in certain parts of Africa, Asia (including the Middle East), and South and Central America

What are the Risk Factors for Glanders? (Predisposing Factors)

Contact with infected animals, specifically donkeys, horses, and mules, increases one’s risk for Glanders. The infection may be contracted by humans from infected pets, such as cats and dogs, including from goats.

The risk factors for Glanders may include: 

• Close and regular contact with infected farm animals or house pets
• Horse rearing for sports or other activities; horses are natural hosts for Burkholderia mallei, the causative pathogen
• Cleaning animal sheds and stables
• Meat handling and storage
• Working in slaughterhouses
• Cleaning dead animals and disposing carcasses of infected animals
• Veterinarians who handle the sick and infected animals
• Children playing with young animals on farms and grazing lands
• Handling raw meat while cooking
• Having open wounds and cuts on the body
• Individuals with weak immune systems have a higher risk for transmission of infection

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Glanders? (Etiology)

Glanders is an infectious disease that affects both humans and animals, caused by gram-negative bacterium Burkholderia mallei, found in soil and water. The bacteria enter the body and spreads through:

• Cuts and sores in the skin
• Mucus membranes
• Inhalation of contaminated dust or droplets
• Ingestion of contaminated water
• Transmission of Glanders from one individual to another is very uncommon

The disease closely resembles another infection called melioidosis (also known as pseudoglanders), which is caused by the bacterium Burkholderia pseudomallei.

What are the Signs and Symptoms of Glanders?

The signs and symptoms associated with Glanders differ from one individual to another. It also depends on the mode of entry into the body (through open wounds or inhaled particulates), and the body systems affected. An incubation period of up to 2 weeks is noted following exposure to B. mallei. Localised infection may involve the skin, while systemic infection may affect the lungs, liver, spleen, and blood.

Common signs and symptoms of Glanders include:

• Fever and chills
• Sweating
• Headache
• Chest pain
• Muscle pain
• Feeling of illness
• Fatigue

Localized Infection may result in:

• Lesions on skin that ulcerate
• Formation of abscesses
• Enlarged lymph nodes (at the neck) and lymphangitis
• Increased mucus discharge at infected mucosal sites such as the nasal cavity, respiratory tract, and eye
• Involvement of the nasal septum and palate may be severe

Pulmonary infection may result in:

• Chest pain
• Cough
• Breathing difficulties
• Nasal discharge
• Abscess formation in the lung
• In some individuals who inhaled the pathogenic bacteria, the skin symptoms may appear after many months following chest infection

Bloodstream infection:

• A wide variety of skin lesions may form such as papules, blisters, ulcers, and abscesses
• Disorientation
• Involvement of many organ systems with severe complications

How is Glanders Diagnosed?

The diagnosis of Glanders may involve the following tests and exams:

• Complete physical examination with evaluation of medical history and occupational history (including contact with animals such as horses and donkeys)
• Isolating B. mallei from blood, urine, sputum, skin lesions, or abscesses by culture test
• Tests to detect an antibody response to the bacteria
• Chest X-ray to see lung involvement
• Skin biopsy, if necessary: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis to eliminate other infections may be considered, before arriving at a definitive diagnosis. These may include:

• Anthrax
• Cat scratch disease
• Invasive Klebsiella infection
• Melioidosis
• Plague
• Sepsis from Staphylococcal infection 
• Tuberculosis
• Tularemia

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Glanders?

The possible complications that could arise from Glanders include:

• Severe emotional stress
• Body organ abscesses: Abscess formation in the liver and spleen
• Pneumonia (bacterial infection of lung) and pleural effusion
• Septicemia (spread of infection in blood), which is a medical emergency
• Multiple organ failure from abscess formation may result in fatalities within 1-2 weeks
• Chronic infection that may persist for many decades, although the symptoms may be less severe

In untreated cases, the infection can progressively worsen and result in death.

How is Glanders Treated?

Once Glanders is diagnosed and confirmed, appropriate medications can be prescribed for treatment. It is informed that both melioidosis and Glanders may be treated in a similar manner, and this may include:

• Intravenous antibiotic therapy followed by oral antimicrobial (antibiotic) therapy
• The intravenous antibiotics that are generally used include ceftazidime and meropenem
• The commonly used oral antimicrobial are trimethoprim-sulfamethoxazole and doxycycline

Regular follow up visits with the healthcare provider is important and recommended.

How can Glanders be Prevented?

Currently, there are no preventive vaccines available for Glanders. However, individuals who are at high risk for the infection may consider the following safety procedures to minimize the risk:

• Ensure that wounds and skin ulcers are properly treated and dressed/covered
• Handwash with soap and water before handling food/meat or eating
• Cook meat thoroughly
• Clean all utensils and food preparation surfaces with soap and water
• Maintain personal and body hygiene
• Wear gloves while handling sick or dead animals, especially to be practiced by veterinarians, farmers/farm hands, and slaughterhouse workers
• Adhere to safety precautions in high-risk work places that deal with animals
• Handle animal specimens under appropriate bio-safety conditions (since lab workers could be at risk)
• In slaughterhouses, separate the slaughtering place from the processing area, to help avoid spread of the bacteria
• Take steps to rear healthy farm animals, such as by vaccinating the herd and cleaning sheds regularly
• Quarantine infected herds and eliminating them from the healthy stock of animals

Individuals with compromised immunity are strongly recommended to avoid handling farm animals or hold similar occupations.

What is the Prognosis of Glanders? (Outcomes/Resolutions)

• With proper and early treatment of Glanders, the prognosis is improved. A correct diagnosis and immediate medical attention can help drastically reduce the mortality rate
• However, if Glanders is left unattended, it may be fatal, especially if septicemia sets in. The infection can also recur in the treated patients, if the predisposing factors are not adequately addressed

Additional and Relevant Useful Information for Glanders:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/