Lipopolysaccharide and capsular polysaccharide virulence factors
Type III and Type VI secretion systems
Disease mechanism by route
Inhalational route
Aerosol exposure leads to alveolar infection
Consolidation, necrosis, abscess formation in lungs
Haematogenous spread to visceral organs
Cutaneous inoculation
Local papule progresses to ulcer
Lymphangitic spread
Bacteremia and systemic dissemination possible
Septicemic dissemination
Haematogenous seeding of liver, spleen, skin, and musculoskeletal system
Multiple organ abscesses
Necrosis of tracheobronchial tree in severe cases
Chronic form pathophysiology
Granuloma formation
Suppurative granulomas in affected tissues
Nodular skin lesions (farcy)
Persistent intracellular reservoir
Incomplete clearance without prolonged eradication therapy
Therapeutic Considerations
Antibiotic susceptibility principles
Intrinsic resistance pattern
Resistance to penicillin, ampicillin, azithromycin, colistin
Resistance to aminoglycosides at lower doses
Reliable susceptibility agents
Ceftazidime (in vitro and animal model data; Kenny et al. 1999)
Carbapenems (imipenem and meropenem)
TMP-SMX for eradication
Variable susceptibility agents
Tetracyclines (doxycycline)
Fluoroquinolones (levofloxacin superior to ciprofloxacin; Judy et al. 2009)
Treatment phase rationale
Induction phase goal
Rapid bacterial load reduction
Prevention of seeding and abscess expansion
Eradication phase goal
Clearance of intracellular bacterial reservoir
Prevention of relapse
6 months for disseminated disease (Lipsitz et al. 2012)
Evidence base limitations
No controlled clinical trials in humans
All recommendations from case reports and animal models
Expert consensus workshop (Lipsitz et al. 2012) primary guidance
Bioterrorism preparedness framework
Post-exposure prophylaxis protocols established
TMP-SMX or doxycycline for 21 days post-exposure
Patient Discharge Instructions
copy discharge instructions
Glanders home care instructions
This is a rare serious bacterial infection; complete full antibiotic course
Do not stop antibiotics without physician approval
Treatment may last 6 months or longer
Take all oral medications exactly as prescribed
TMP-SMX with plenty of fluids
Doxycycline with food to reduce stomach upset
Follow all infection control instructions
Cover any skin wounds or draining lesions
Wash hands thoroughly after touching wounds
Return to emergency department immediately for
Difficulty breathing or worsening shortness of breath
Fever not improving or spiking higher on treatment
New skin wounds, swellings, or draining lesions
Confusion, severe headache, or neck stiffness
Signs of allergic reaction to antibiotics
Rash, hives, swelling of face or throat
Inability to keep oral medications down
Yellowing of skin or eyes (jaundice)
Follow-up plan
Infectious disease specialist within 1 week of discharge
Repeat blood work at scheduled intervals
Repeat imaging at 2 to 4 weeks to assess treatment response
Public health follow-up as directed
Animal contact restriction
Avoid equine contact until cleared by physician
Report any additional sick animals to veterinary authorities
References
Guidelines and key sources
Primary guideline references
Lipsitz R et al. Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection 2010. Emerging Infectious Diseases 2012. PMID 23171644
Van Zandt KE, Greer MT, Gelhaus HC. Glanders: An Overview of Infection in Humans. Orphanet Journal of Rare Diseases 2013. PMID 24004906
Srinivasan A et al. Glanders in a Military Research Microbiologist. New England Journal of Medicine 2001. PMID 11474078
Antimicrobial susceptibility references
Kenny DJ et al. In Vitro Susceptibilities of Burkholderia mallei in Comparison to Those of Other Pathogenic Burkholderia SPP. Antimicrobial Agents and Chemotherapy 1999. PMID 10543761
Judy BM et al. Comparison of the in Vitro and in Vivo Susceptibilities of Burkholderia mallei to Ceftazidime and Levofloxacin. BMC Microbiology 2009. PMID 19426516
Diagnostic references
Wagner GE et al. Protein Microarray-Guided Development of a Highly Sensitive and Specific Dipstick Assay for Glanders Serodiagnostics. Journal of Clinical Microbiology 2023. PMID 36541753
Wernery U et al. Development of a Sensitive Competitive Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Burkholderia mallei. PLoS Neglected Tropical Diseases 2021. PMID 34932554
He G et al. A Case Report of Infection Leading to Pneumonia. Combinatorial Chemistry and High Throughput Screening 2022. PMID 35579163
Animal model and pathogenesis references
Yingst SL et al. Pathological Findings and Diagnostic Implications of a Rhesus Macaque Model of Aerosol Exposure to Burkholderia mallei. Journal of Medical Microbiology 2015. PMID 25850696
Coding standards
ICD-10 A24.0 glanders
ICD-10 A24.4 melioidosis for differential coding
SNOMED CT glanders disorder concept
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.