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Glanders

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Walters

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Pvt. David Walters, (USA) (1845 - 1865)
as a Private on 15 November 1864 in Company L, 7th Cavalry Regiment Indiana. Died Company L, 7th Cavalry Regiment Indiana on 26 Sep 1865 at Hempstead, Texas.He lived 19 years,10 months, and 25 days...H...

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Please add the profiles of those who died from Glanders.

Even though this disease is associated with horses, donkeys & mules, Glanders can be transmitted to humans.

Glanders (from Middle English glaundres or Old French glandres, both meaning glands; Latin: malleus, German: Rotz; also known as "equinia", "farcy", and "malleus") is a highly contagious infectious disease that occurs primarily in horses, mules, and donkeys. It can be contracted by other animals, such as dogs, cats, goats and humans, and can be a cause of death if untreated.

Glanders is caused by the gram negative rod bacteria, Burkholderia mallei (burk- hol-dare-EE-ah MAL-EE-eye) and is an obligate pathogen of mammals (ie, there is no environmental reservoir).
Glanders was once common throughout the world but programs to eradicate the disease have been successful in many countries.
- Glanders is not presently found in the United States but does occur in parts of the Middle East, Asia, Africa and South America.
Glanders causes respiratory infection and skin lesions in equine and humans.

Signs & Symptoms:

Glanders is a very painful disease and can lead to death without treatment.
The particular symptoms experienced, however, will vary depending on the type of infection.
Symptoms 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)
(From: Anthrax, Plague, Diphtheria, Trachoma, and Miscellaneous Bacteria. By Stephen K. Tyring in Tropical Dermatology (Second Edition), 2017)
- After an incubation period of 1 day to 2 weeks, glanders can present with fever and any of four clinical manifestations:
  - 1. A nodule with lymphangitis at the site of inoculation; the nodule eventually breaks down and ulcerates
  - 2. Mucous membrane ulceration and granulomatous reaction
  - 3. Septicemia with cutaneous papules and pustules
  - 4. Pulmonary form with malaise, headache, and pleurisy.

There are four types of infections, along with the symptoms associated with each.

1. 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.

2. 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.
Signs 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.
Acute pulmonary infections may require anywhere from 10–14 days of incubation before symptoms appear. Septicemia may develop immediately after exposure or up to two weeks after initial infection.
- Pneumonic disease usually has a rapid onset and is almost uniformly lethal between 10 and 30 days in untreated cases, while survivors act as carriers.

3. Bloodstream infections:

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

4. Chronic infections:

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.

Transmission to humans: Can I get glanders?

Yes, people can get glanders by having direct contact with infected animals, consuming food or water contaminated by the nasal discharge of the animal or contaminated objects.

The bacteria that cause glanders are transmitted to humans by contact with tissues or body fluids of infected animals through the skin (wounds, cuts, abrasions) or through surface of 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, farriers, and laboratorians.
Cases of human-to-human transmission have not been reported in the U.S.

How serious is it for us?

The mortality rate for the pulmonary form of glanders has been reported to be 90-95 per cent without treatment and up to 40 per cent with treatment. The disease can affect the skin, lungs or the entire body. Signs may include fever, chills, muscle aches, and chest pain; pneumonia can rapidly develop. Nodules or ulcers may occur in the skin or the nose, eyes, or mouth. 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.
Conjunctivitis, weeping, allergy to light, swelling of the nose and face, coughing and headaches are common. Pneumonia, pulmonary abscesses can occur. The chronic form of glanders involves abscesses within the muscles of the arms and legs or in the spleen or liver. A glanders node may appear as a single blister, gradually developing into a weeping ulcer. Symptoms can develop one to five days after infection. Ultrasonography may reveal multiple, small abscesses in both the liver and the kidney.
There is no treatment regimen beyond trying out different antibiotics.

How can I protect myself from glanders?

Prevention for people involves identifying and eliminating the disease in the animal population. If you see the signs or symptoms of glanders in a horse, mule or donkey, call your veterinarian immediately and avoid contact with the animal. Wearing gloves and hand washing after contact with infected animals can greatly minimize your risk.
A wide variety of national and international regulations exist, and glanders is a reportable disease for the OIE and many countries.

History and Wars:

Glanders infection in man is infrequent even during outbreaks of disease in horses. The disease has been recognized almost since man began recording equine diseases. Hippocrates reported clinical signs of the disease in around 425 BC.

Glanders has had a long association with warfare dating from at least the 4th century AD, when Apsyrtus, serving as a veterinarian in the army of Constantine the Great, described both glanders and farcy. Almost 100 years later, Aristotle described the disease under the general term for epizootics, and named it ‘melis’. Vegetius, a Roman military historian in the 5th century AD, applied the name ‘malleus’ (Latin for ‘hammer’) to the disease in recognition of the ‘force with which the disease strikes horses’. Vegetius recognized Glanders as contagious and recommended the separation of infected from non-infected horses.

The horse is thought to be the natural reservoir of infection and man an accidental host. Infection in man can occur via the cutaneous or inhalation routes.
Glanders was prominent during the Crusades and other military engagements. The contagious nature of the disease was recognized by Sollysel in France in 1664. The French king Louis XV commissioned the first veterinary school at Lyons under Claude Bourgelat in 1761 with the purpose of investigating glanders in an attempt to protect French army horses. The horse was an important component of early warfare because it is both easily maneuvered and can be used for transport, a fact that placed the army with the healthiest horses at a considerable advantage. Because of the organism’s proclivity towards infection of draft animals, B. mallei became a potential weapon of war. At a time when horses were crucial to military campaigns, both for cartage and cavalry, an outbreak of glanders among horses could devastate military readiness and alter the course of battle. Glanders was widespread among the horses of both sides during the American Civil War (Sharrer, 1995).

The horse continued to play an important role in warfare until the 20th century. Due to the high mortality rate in humans and the small number of organisms required to establish infection, B. mallei is regarded as a potential weapon for bioterrorism. It was one of the first biological warfare agents used in the 20th century.

During World War I was the first marked interest in the use of B. mallei as a bioweapon. Between 1914 and 1918, 58,843 horses in the French Army were reported to be affected with glanders. Glanders was believed to have been spread deliberately by German agents against the Allies’ horses and livestock and to infect Russian horses and mules on the Eastern Front. Human cases in Russia increased with the infection during and after WWI. Other agents attempted to introduce the disease in the United States and Argentina. This had an effect on troop and supply convoys, as well as on artillery movement, which were dependent on horses and mules.

The Japanese deliberately infected horses, civilians, and prisoners of war with B. mallei at the Pinfang (China) Institute during World War II. The former Soviet Union was also alleged to have used B. mallei against opposition forces in Afghanistan between 1982 and 1984. The US studied this agent as a possible biological weapon in 1943–44, but did not weaponize it. Together with the high rate of infectivity through breathing contaminated air, and resistance to many common antibiotics, this bacteria has been classified as a category B priority pathogen by the United States National Institute of Health and Centre for Disease Control.

There are currently no vaccines for use in either man or horse, and treatment with a limited range of antibiotics is prolonged and frequently ineffective with mortality rates in man extending to 40%.

The eradication of glanders from many countries over the last century has been effected as a result of a number of factors including improved diagnostics, trade restrictions on countries affected, and the industrial revolution which saw the horse give way to other means of transport, particularly in times of armed conflict. Today the disease is restricted mainly to South America, northern Africa, and parts of Asia and the Middle East. It is considered endemic in Iraq, Pakistan, India, Mongolia and parts of Brazil. However, over the last 10–20 years, the frequency of outbreaks of glanders has appeared to increase and has led to the classification of glanders as a re-emerging disease

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, and 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 (including farriers), laboratorians, equine butchers, and abattoir workers.