Glanders is endemic in Africa, Asia, the Middle East, Central and South America. It has been eradicated from North America, Australia and most of Europe through surveillance and destruction of affected animals, and import restrictions.
Glanders is a rare nfectious disease caused by the bacterium Burkholderia mallei. It is primarily a disease of horses, donkeys and mules, though other animals such as goats, cats and dogs can be infected. Humans can get the disease, but it is rare. Burkholderia mallei is an organism that is associated with infections in laboratory workers because so very few organisms are required to cause disease. The bacteria enter the body through the skin and through mucosal surfaces of the eyes and nose. The organism has been considered as a potential agent for biological warfare and of biological terrorism.
Symptoms of glanders include the formation of nodular lesions in the lungs and ulceration of the mucous membranes in the upper respiratory tract. The acute form results in coughing, fever and the release of an infectious nasal discharge, followed by septicaemia and death within days. In the chronic form, nasal and subcutaneous nodules develop, eventually ulcerating.
Death can occur within months, while survivors act as carriers. Symptoms usually appear within 1 to 14 days after exposure. Chronic infections with slow progression of an insidious disease are more common than the acute form of glanders. The acute form (more common in donkeys and mules than in horses) typically progresses to death within about a week. The nasal form of glanders is characterized by unilateral or bilateral nasal discharge. The yellowish-green exudate is highly infectious. The nasal mucosa has nodules and ulcers. These ulcers may coalesce to form large ulcerated areas, or they may heal as stellate scars of the mucosa.
In some cases the septum may even be perforated. Nasal lesions are accompanied by enlargement and induration, or sometimes rupture and suppuration, of regional lymph nodes. There is no vaccine available for glanders. In countries where glanders is found in animals, the disease can be prevented in humans by identifying and eliminating the infection in the animal population. Antibiotics are not routinely used to prevent infections but may be considered by a health care professional. The drug of choice is a sulfa-based drug called TMP-SMX. Some medicine has been found to work in experiments with animals and humans.
