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Key Diagnostic Tests.

• pulmonary form: cough, nasal discharge.
• cutaneous form: multiple, purulent, cutaneous eruptions, often appearing along lymphatic vessels;
• presence of small bacilli in lesions showing irregular staining with methylene blue: the organism is rare in lesions and easy to miss.
• Specific diagnosis (differentiating it from B. pseudomallei ) can be made only by characterization of the isolated organism.

Typically a disease of livestock (horse, ass, mule, dog, sheep, goat), it is highly contagious and humans can contract the disease from infected animals or people by inhaling the highly infective bacteria. The disease is almost always fatal when not treated, and even when treated, the chronic form of the disease kills 50-70% of those infected.

After infection by inhalation or through skin abrasions the disease has a 2-5 day incubation period. Infection through the skin leads to ulceration of the skin, mucous membranes and soft tissues. Infection by inhalation leads to acute glanders that primarily affects the upper respiratory tract (mouth, nose, throat) in the same way. Chronic glanders affects the joints and muscles forming ulcerated and purulent (pus-forming) lesions. The disease is no longer found in humans in the western hemisphere but is still a concern for farmers and veterinarians.

Medical and Physical Countermeasures.

Little attention has been paid to glanders as a disease of humans and so there is little work on prophylactic measures, such as vaccines, or the development of antibiotic treatment regimes.

Vaccination (Immunoprophylaxis)

A vaccine is not available.

Antibiotics

The traditional veterinary treatment of streptomycin and sulfadiazine is somewhat effective. B. mallei is less resistant to antibiotics than are many other Pseudomonads and it may be treated with sulfamethoxazole-trimethoprim, ceftazidime, and doxycycline.

Supportive care

Treat symptoms as necessary. Suppurations should be drained.

Decontamination

Decontamination can be achieved with common disinfectants, heat treatment to >72°C (130°F), or by exposure to ultraviolet (UV) light.

Agent Properties and Potential Uses

Glanders is both contagious and infective, and is relatively unknown in the west. Post-attack diagnosis and treatment would be complicated by this lack of knowledge even in countries with highly developed medical facilities. In addition, patients who recover do not develop a protective immunity and so the agent could be reused. It can withstand drying for 2-3 weeks, but is killed by sunlight and high temperatures.

Terrorist Acquisition and Attempted Use.

• None known.

The History and Natural History of Glanders.

Glanders is a disease of horses and their relatives (known collectively as Equidae.) Although the disease affects many other mammals, the only reservoir of the disease is the horse. Chronic or subclinical (showing no sign or symptom) infections are typical in horses, but not in humans or other mammals.

The acute form of the disease can kill a horse in a couple of weeks and so can be a major challenge to horse-dependent communities or societies. Although individual animals can be treated with antibiotics, eradication of the disease after it has become established can mean destruction of infected animals regardless of value to the owner.

The disease is usually caught from an infected horse, e.g. if it coughs or sneezes on a handler, or from horse meat. Infection of animals other than Equidae does not lead to the disease becoming established in a new population.

Glanders is an ancient disease and has probably been known to man since horses were first domesticated. The disease is mentioned in passing in Shakespeare (The Taming of the Shrew) and in Dumas (The Three Musketeers) indicating that it had become part of the fabric of everyday life before horsepower came from the internal combustion engine. Nowadays, glanders is extremely rare in humans and a physician who does not practice in an area where horses are important may never see a case.

Glanders shares with anthrax and plague the distinction of use in war. The Soviet Army is reported to have used it on a small scale in Afghanistan in the 1980's. This may have been little more than taking an opportunity to conduct limited field tests using a live agent under genuine field conditions.