Glanders is an infectious disease that is caused by the bacterium Burkholderia mallei. While people can get the disease, glanders is primarily a disease affecting horses. It also affects donkeys and mules and can be naturally contracted by other mammals such as goats, dogs, and cats.

What is glanders?

Glanders is a disease caused by the bacteria, Burkholderia mallei. Glanders mostly occurs in horses, mules and donkeys. Humans can get the disease, but it is rare. Laboratory workers and those in direct contact with infected animals have become sick with glanders. Glanders has not been seen in the United States since 1945. It is thought by the U.S. Centers for Disease Control and Prevention (CDC) that glanders could be used as a weapon.

Glanders can occur as the following infections:

• Local infection of skin (cutaneous) or mucous membranes (upper respiratory)
• Pulmonary infection (lungs)
• Septicemic form (bloodstream)

Human cases may result from a combination of all three infections.

How can someone come into contact with glanders?

Glanders can spread from person to person. Humans can come into contact with it when —

• Bacteria enter a cut or open wound; or
• Bacteria are inhaled.

Glanders as a weapon: As a weapon, glanders may be aerosolized and released into the air.

Please note: Just because you come into contact with glanders does not mean you will get sick from it.

What happens if someone gets sick from glanders?

The symptoms of glanders depend on how a person gets it.

• Cutaneous infection (skin): A patient will have swelling and sores at the site of the skin infection. The person also may have swollen lymph nodes.
• Upper respiratory infection: A patient will have mucus or pus discharge from the mouth, nose or eyes.
• Pulmonary infection (lungs): When the lungs are infected, a person may develop pneumonia, have an abscess in the lungs or have large pockets of fluid in the lung cavity.
• Septicemic form (bloodstream): This form of infection develops when the bacteria spread to the bloodstream from other parts of the body such as the skin or lungs. It can cause fever, shivers, sweats, lack of energy, chest pain and diarrhea.

How likely is someone to die from glanders?

Most cases of glanders do not result in death unless the infection spreads to the bloodstream. In those cases, the person will usually die within seven to 10 days. It is unknown how deadly the other forms of glanders are because there have been no cases in the United States since 1945.

What is the treatment for glanders?

• Prevention of illness after contact: Antibiotics are not routinely used to prevent infections but may be considered by a health care professional. The drug of choice is a sulfa-based drug called TMP-SMX.
• Treatment of illness: Because human cases of glanders are rare, there is little information about the effectiveness of antibiotic treatment. Some medicine has been found to work in experiments with animals and humans. Your health care provider will determine the best course of treatment.

Is there a vaccine for glanders?

There is no vaccine for glanders.

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.

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.

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

Since human cases of glanders are rare, there is limited information about antibiotic treatment in humans. Sulfadiazine has been found to be effective in experimental animals and in humans.

In addition, the bacterium that causes glanders is usually susceptible to:

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

In 2010, HHS convened a workshop with internationally recognized leaders in the field of Burkholderia species(the species of germ that causes melioidosis, glanders and other related infections) and clinicians with expertise in treating Burkholderia. Workshop attendees recommended treatment regimens for and post-exposure prophylaxis for melioidosis and glanders.

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 and airborne precautions.

Glanders is a disease that usually affects horses, donkeys, and mules. While the disease still occurs in certain parts of the world, no animal in the United States has gotten sick with glanders since the 1940s. Though not common, people have gotten glanders from sick animals. People who are in close contact with animals that have glanders are more likely to get the disease than those who are not.

In the past, the germs that cause glanders, the bacteria called Burkholderia mallei, have been used as a biological weapon during war. It is possible that these germs could be used again in a biological attack. A biological attack is the intentional release of germs that can sicken or kill people, livestock, or crops. Public health authorities study this disease to be prepared if a biological attack ever happens.