Glanders and Melioidosis

Signs and Symptoms

Incubation period ranges from 10-14 days after inhalation. Onset of symptoms may be abrupt or gradual. Inhalation exposure produces fever (common in excess of 102 F.), muscle stiffness, sweats, muscle pain, headache, chest pain, cervical glandular inflammation, abnormal enlargement of both the liver and the spleen, and generalized pustular skin eruptions. Acute pulmonary disease can progress and result in severe septic bacterial infections and acute septic disease. Glanders and Melioidosis are almost always fatal without treatment.

Diagnosis

Methylene blue or Wright stain of exudates may reveal scant small bacilli with a safety-pin bipolar appearance. Standard cultures can be used to identify both B. mallei and B. pseudomallei. Chest x-rays may show lesions, small multiple lung abscesses, or infiltrates involving upper lungs. White cell counts may be normal or elevated. Serologic tests can help confirm diagnosis, but a negative serology does not exclude the diagnosis.

Treatment

Therapy will vary with the type and severity of the disease. Patients with localized disease may be managed with oral antibiotics for a period of 60- 150 days. More severe illness may require injection therapy rather than oral mediation, and more prolonged treatment.

Preventative Measures

Currently, no pre-exposure or post-exposure drugs available.

Isolation

Standard Precautions for healthcare person-to-person airborne transmission is unlikely, although secondary cases may occur through improper handling of infected secretions. Contact Precautions are indicated while caring for patients with skin involvement.