Malleus A24.0

Glanders is an infectious disease of odd-toed ungulates (Perissodactyla), but especially of the Equidae, caused by Burkholderia mallei, a Gram-negative, aerobic, non-motile bacterium (Smith ME et al. 2019). The main hosts for Burkholderia mallei are horses, donkeys and their cross-breeding products (Kettle AN et al. (2016). The zebra is also a potential host. Likewise, the internationalisation of equestrian sports has made the occurrence of glanders infection possible again in Europe (Kettle AN et al. 2016). In close contact with infected odd-toed ungulates, other mammalian species besides humans can be infected (e.g. camels of rare dogs, cats and goats).

Occurrence mainly in Asia, South America and Africa. A zoonosis rarely occurring in humans.

Disease and death must be reported (see below reporting obligation).

Burkholderia mallei (gram-negative, rod-shaped, aerobic bacterium)

In Germany, the last case in the native equine population occurred in 1955, the last case in 1995, and the last case of red spot disease in humans was diagnosed in Germany in 1973. Between 1996 and 2003, glanders occurred in Bolivia, Brazil, Eritrea, Ethiopia, Iran, Latvia, Mongolia, Myanmar, Pakistan, Turkey and Belarus. In Brazil, animal glanders remains a significant veterinary and environmental problem (Fonseca-Rodríguez O et al. 2019). During the same period, cases of human red blood cells were reported from Cameroon, Curaçao, Sri Lanka, Turkey and the USA (laboratory infection). In 2007, outbreaks of glanders in horses were again reported from India (Kashmir) and Russia (southeast Siberia).

Transmission of the pathogen mainly through contact with nasal and ulcer secretions of diseased animals. The main sources of infection are horses, through which humans are directly infected (nasal secretion or meat of sick animals). In this respect, horse owners, farmers, veterinarians, etc. are the main sufferers.

Incubation period a few days up to 2-3 weeks. Depending on the course of the disease four forms are distinguished:

1. Acute fulminant form: sudden onset with headache, aching limbs, chills, nausea, vomiting.
2. Acute skin rash (dermatitis malleosa): Inflammatory reddened swelling; often central pustule at the inoculation site. Transformation into jagged, undermined, purulent ulcer = primary effect with painful regional lymphangitis acuta and lymphadenitis. Generalization with severe general symptoms. Intermittent development of macular, later bullous or pustular, ulcerous lesions(snot ulcers). Infection of the mucous membranes. Lethal outcome in the 2nd to 3rd week of illness with involvement of internal organs.
3. Chronic form: On the face, runny skin and/or extremities, gradual development of ulcerative, sportrichoid nodules and poorly healing ulcerations. Accompanying limb or joint pain. Mucous membrane: Infiltration, abscesses, ulcerations, mutilations = malleus mutilans.
4. Primary nasal snot: Entry portal: Nasal mucosa. Swelling, pustules, ulcers, viscous, bloody secretion. Nasal breathing becomes impossible. Descent of the changes, danger of suffocation, sepsis.

Tuberculosis cutis miliaris disseminata

Typhoid

Syphilis

Sporotrichosis

Erysipelas

multiple bacterial abscesses.

Systemic antibiotic therapy following an antibiogram is necessary, possibly over long periods of time. In addition, use of antiseptic topicals, e.g. with antiseptic lapels and dressings.

Sulphonamides are recommended (sulphadiazine in a dosage of 120mg/kgkgKG/day parenterally for 2-3 weeks).

Alternatively: Ceftazidim 120mg/kgkgKg in combination with trimethoprim 8mg/kgKG and 40mg/kgKg sulfmethoxazole.

Therapeutic hopes relate to the development of an effective vaccine for glanders and melioidosis (Johnson MM et al. 2017).

Because of its human pathogenicity (Saikh KU et al. 2017), its resistance to numerous antibiotics (Rhodes KA et al. 2016) and its potentially high contagiousness, Burkholderia mallei is classified as a class B biological warfare agent (Smith ME et al. 2019).

1. Boerner P (1882) A preliminary report on work by the Imperial Health Care Office leading to discovery of the glanders bacillus. German Med Vschr 52: 707-708
2. Fonseca-Rodríguez O et al (2019) Spatiotemporal Analysis of Glanders in Brazil. J Equine Vet Sci 78:14-19.
3. Johnson MM et al. (2017) Vaccines for the Prevention of Melioidosis and Glanders. Curr Trop Med Rep 4:136-145.
4. Kettle AN et al (2016) Glanders and the risk for its introduction through the international movement of horses.Equine Vet J 48:654-658.
5. Rayer PFO (1837) De la morve et du farcin chez l'homme. Baillière, Paris
6. Rhodes KA et al (2016) Antibiotic resistance in Burkholderia species. Drug Resist Update 28:82-90.
7. Saikh KU et al. (2017) Innate immune response to Burkholderia mallei. Curr Opin Infect Dis 30:297-302.
8. Smith ME et al (2019) Glanders And Melioidosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
9. Smith ME et al.(2019) Biologic Warfare Agent Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019