Technical Information
Technical information is taken directly from the December 2002 CDC Division of Bacterial and Mycotic Diseases: Glanders

Clinical Features
Primarily a disease of horses, mules, and donkeys. In humans, disease can occur in four basic forms: acute localized infection, blood poisoning illness, acute pulmonary infection, or chronic skin infection. Symptoms include fever, tiredness, chest pain, swelling of the cervical lymph nodes, enlarged spleen, and generalized skin eruptions. Mortality rate is over 50% despite antibiotic treatment.

Etiologic Agent
Burkholderia (formerly Pseudomonas) mallei, a gram-negative bacillus, seldomly occurs in humans. No naturally acquired cases have occurred in the United States in almost 60 years. Cases continue to occur in Asia, Africa, the Middle East, and South America.

Transmission
B. mallei is generally transmitted from animals to humans by invasion of nasal, oral, and conjunctival mucous membranes; by inhalation into the lungs; or through lacerated or open skin wounds.

Risk Groups
Veterinarians, horse and donkey caretakers, workers in laboratories where the organism is being handled or in areas where equines may be infected.

Surveillance
No national or state surveillance exists.

Trends
Remains extremely rare in humans. In 2000, one case occurred in a laboratory worker.

Challenges
Development of rapid laboratory, clinical, and epidemiologic protocols for the timely detection of glanders infections resulting from bioterrorism.

Opportunities
Determining antibiotic susceptibility patterns among isolates of Burkholderia mallei.