glanders
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Etiology
- infection with Burkholderia mallei[1]
Epidemiology
- contact with infected
- endemic in Africa, Asia, the Middle East, Central & South America
- eradicated from North America, Australia & most of Europe through surveillance & destruction of affected animals, & import restrictions
- person to person transmission unlikely[5]
Clinical manifestations
- abrupt onset of symptoms
- high fever/chills
- myalgias
- nausea/vomiting
- lymphadenopathy
- localized swelling
- miliary lesions along lymphatic & subcutaneous tissues
- disseminated granulomatous lesions
- abscesses in skin & respiratory tract
- chronic form with nasal & subcutaneous nodules that eventually ulcerate
Laboratory
- positive skin testing
- positive complement fixation test
- cultures
- complete blood count (CBC): leukocytosis
Radiology
Complications
- death can occur with days to months
- survivors can be carriers
Management
- in hospital treatment
- isolation; barrier & secretion precautions
- imipenem, ceftazidime, or meropenem plus either ciprofloxacin or doxycycline
- intravenous therapy may last as long as 2-3 weeks followed by a switch to oral antibiotics (ciprofloxacin, doxycycline, TMP/SMX, or amoxicillin/clavulanate) for up to 150 days in order to prevent reactivation[5]
- oral antibiotics (eradication)
- amoxicillin clavulanate
- doxycycline
- Bactrim
- alternative imipenem cilastin with or without Bactrim
- for local disease with mild-moderate toxicity, use 2 of 3 antibiotics for 30 days, then switch to monotherapy for completion of 60-150 day course[5]
- for extrapulmonary suppurative disease, 6-12 months of antibiotic therapy is recommended[5]
- abscesses may need to be drained
- no proven postexposure prophylaxis
- no vaccine
- reportable disease, contact local health department
More general terms
Additional terms
References
- ↑ 1.0 1.1 DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 887
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 227
- ↑ Wikipedia: Glanders http://en.wikipedia.org/wiki/Glanders
- ↑ Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncidod/dbmd/diseaseinfo/ glanders_g.htm
- ↑ 5.0 5.1 5.2 5.3 5.4 eMedicine. Glanders and Melioidosis http://www.emedicine.com/emerg/topic884.htm