Burkholderia mallei

Background

• Causes glanders (also known as equinia, malleus, droes, and farcy)

Microbiology

• Gram-negative bacillus
• Oxidase variable

Epidemiology

• Zoonotic infection acquired from horses, mules, and donkeys
• May be an agent of bioterrorism

Clinical Manifestations

• Acquired primarily from horses
• Incubation period ranges from 1 to 14 days, though in chronic infections it can be up to several months
• Typically starts with localized infection at site of inoculation (skin within a few days, or lungs within 1-2 weeks)
• Low-grade fevers, malaise, fatigue, headache, myalgias including back ache, lymphadenopathy and chest pain
  • Natural history may have a biphasic clinical course, with initial improvement followed by worsening and death
• Most often characterized by ulcerating lesions of the skin and mucosal surfaces
  • If disseminated, can appear anywhere
  • Pain and swelling, developing into an ulcer that can become hemorrhagic
  • Can present with nodular lymphangitis
• Pneumonic form presents with pneumonia, lung abscesses, empyema, and pleural effusions
• When it disseminates, it can cause abscesses in multiple organs (lungs, liver, spleen)

Management

• Treatment is with ceftazidime, imipenem, doxycycline, or TMP-SMX

Further Reading

• Glanders: an overview of infection in humans. Orphanet J Rare Dis. 2013;8:131. doi: 10.1186/1750-1172-8-131. PMID: 24004906; PMCID: PMC3766238.