Transmission

The bacteria that cause glanders are transmitted to humans through contact with tissues or body fluids of infected animals. The bacteria enter the body through cuts or abrasions in the skin and through mucosal surfaces such as the eyes and nose.
It may also be inhaled via infected aerosols or dust contaminated by infected animals. Sporadic cases have been documented in veterinarians, horse caretakers, and laboratorians.
Cases of human-to-human transmission have not been reported in the U.S.

Signs and Symptoms

Symptoms of glanders commonly include:

• Fever with chills and sweating
• Muscle aches
• Chest pain
• Muscle tightness
• Headache
• Nasal discharge
• Light sensitivity (sometimes with excessive tearing of the eyes)

The particular symptoms experienced, however, will vary depending on the type of infection. The four types of infections, along with the symptoms associated with each, are listed below.

Localized Infection

If there is a cut or scratch in the skin, a localized infection with ulceration may develop within 1 to 5 days at the site where the bacteria entered the body. Swollen lymph nodes may also be apparent.
Infections involving the mucous membranes in the eyes, nose, and respiratory tract will cause increased mucus production from the affected sites. Dissemination to other locations in the body may occur 1-4 weeks after infection.

Pulmonary Infection

Glanders often manifests itself as pulmonary infection. In pulmonary infections, pneumonia, pulmonary abscesses, and pleural effusion can occur. Chest X-rays will show localized infection in the lobes of the lungs.

Bloodstream Infection

Without treatment, glanders bloodstream infections are usually fatal within 7 to 10 days.

Chronic Infection

The chronic form of glanders involves multiple abscesses within the muscles and skin of the arms and legs or in the lungs, spleen, and/or liver.

Risk of Exposure

No naturally occurring cases of glanders have been reported in the United States since the 1940s.
However, there are sporadic reports of glanders from the following regions:

• Africa
• Asia
• The Middle East
• Central America
• South America

In addition, those who care for affected animals or handle infected specimens may also face an increased risk. Such persons can include:

• Veterinarians
• Horse Caretakers
• Laboratorians
• Equine Butchers
• Abattoir Workers

Treatment

Since human cases of glanders are rare, there is limited information about antibiotic treatment in humans. Sulfadiazine has been found to be an effective in experimental animals and in humans.
In addition, the bacterium that causes glanders is usually susceptiple to:

• Tetracyclines
• Ciprofloxacin
• Streptomycin
• Novobiocin
• Gentamicin
• Imipenem
• Ceftrazidime
• Sulfonamides

Prevention

Presently, there is no vaccine available for glanders.
In countries where glanders is endemic in animals, prevention of the disease in humans involves identification and elimination of the infection in the animal population.
Within the health care setting, transmission can be prevented by using standard contact precautions.