Glanders: an overview of infection in humans

Abstract

Glanders is a highly contagious and often fatal zoonotic disease, primarily of solipds. In the developed world, glanders has been eradicated. However, prior use of B. mallei as a biological weapon and its high mortality in inhalation animal studies has affirmed B. mallei as a biodefense concern. This threat requires the development of new glanders medical countermeasures (MCMs), as there is a lack of an effective vaccine and lengthy courses of multiple antibiotics needed to eradicate B. mallei. Here, we present a literature review of human glanders in which we discuss the clinical epidemiology and risk factors, potential routes of exposure, symptoms, the incubation period, and specific diagnostics. This review focuses on pulmonary glanders, as this is the most likely outcome of a biological weapons attack. Additionally, we outline current treatment regimens and propose a clinical definition of human pulmonary glanders infection.

Antibodies against In Vivo -Expressed Antigens Are Sufficient To Protect against Lethal Aerosol Infection with Burkholderia mallei and Burkholderia pseudomallei

“…rity threat (7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The genetic relatedness between the organisms indicates that B. mallei evolved from B. pseudomallei through a process of genomic reduction (24)(25)(26)(27).…”

“…In addition to their high level of genomic relatedness, the clinical and pathological manifestations of disease caused by B. mallei and B. pseudomallei are markedly similar. Infection typically occurs via the respiratory route or through punctured skin, and the most common presentations are life-threatening pneumonia and bacteremia (2,3,10,11,18). A key aspect of pathogenesis by both B. mallei and B. pseudomallei that complicates treatment is their ability to invade and to survive and replicate within host cells, including professional phagocytes (5,7,42,43).…”

“…This ability to thrive intracellularly promotes dissemination to target tissues (liver, lungs, spleen, and lymph nodes), where the organisms form hallmark chronic lesions and granulomas that are difficult to treat. Glanders and melioidosis are difficult to diagnose and require prolonged antibiotic therapy with low success rates (2,3,10,11,18,44,45). B. mallei and B. pseudomallei are also resistant to most antibiotics, which limits treatment options (46)(47)(48)(49)(50).…”

Burkholderia mallei CLH001 Attenuated Vaccine Strain Is Immunogenic and Protects against Acute Respiratory Glanders

“…Glanders is primarily a disease of solipeds, with rare cases occurring among humans (1,2). Naturally acquired human cases occur in areas of endemicity, particularly among those exposed to infected solipeds (2)(3)(4). Additionally, cases have been reported among laboratory workers (5,6).…”

“…Disease course and severity are route dependent, with respiratory cases being the most severe (3). Respiratory infection is characterized by rapid onset of symptoms, including fever, lymphadenopathy, pulmonary abscesses, pneumonia, disseminated organ infection, and, ultimately, septicemia (3,5,10).…”