CBRNE - Glanders and Melioidosis Clinical Presentation

  • Author: Paul P Rega, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Feb 10, 2011
 

History

  • Glanders is transmitted to humans through direct skin or mucous membrane contact with infected animal tissues. Cases of human-to-human transmission have been reported.
  • Melioidosis is transmitted to humans through direct skin contact with contaminated soil or water. Ingestion of contaminated water and inhalation of dust contaminated with the organism are other mechanisms of transmission. Cases of human-to-human transmission are rare but have been documented.
  • Generalized symptoms include fever, rigors, night sweats, myalgia, anorexia, and headache. Additional symptoms, which are based on the route of exposure, include chest pain, cough, photophobia, lacrimation, and diarrhea.
  • There is nothing specific about these diseases and a strong clinical suspicion is required to assist in making a diagnosis in endemic regions. This is particularly true for patients with predisposing comorbidities, such as diabetes mellitus, chronic renal failure, alcoholism or malignancy; those who are immunosuppressed as the result of either diseases or drug treatment; and those living in or with a history of travel to endemic areas. However, in the event of an intentional bacteriological attack in other regions of the world, the above subsets of patients will be the most affected.[8]
Next

Physical

Physical findings may include fever, cervical adenopathy, papular or pustular skin lesions, hepatomegaly, or splenomegaly.

  • Severe urticaria has been reported during primary melioidosis.
  • During septicemia, flushing, cyanosis, and a disseminated pustular eruption can be seen. Pustules often are associated with regional lymphadenitis, cellulitis, or lymphangitis.
  • Rarely, ecthyma gangrenosum–like lesions and cutaneous abscesses (that sometimes ulcerate) may develop.

Specifically, in melioidosis septicemia, high fevers and rigor are present. These findings may be accompanied by confusion, dyspnea, abdominal pain, muscle tenderness, pharyngitis, diarrhea, and jaundice. While the typical foci in these severe cases begin from the skin or the lungs, metastasis (liver, spleen, kidney, brainstem, parotid gland) will occur, leading to acidosis, shock, and death within 48 hours of presentation.

Previous
Next

Causes

  • Human cases of glanders have occurred primarily in occupational settings and include laboratorians, veterinarians, and animal caretakers.
  • Human cases of melioidosis have occurred from sexual contact and intravenous drug use. It has been observed in immigrants, military personnel, and travelers.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Paul P Rega, MD, FACEP  Assistant Professor, Department of Public Health and Preventive Medicine, The University of Toledo College of Medicine; Assistant Professor, Department of Emergency Medicine, The University of Toledo College of Medicine; Director of Emergency Medicine Education and Disaster Management, OMNI Health Services

Paul P Rega, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Bondi SK, Goldberg JB. Strategies toward vaccines against Burkholderia mallei and Burkholderia pseudomallei. Expert Rev Vaccines. Nov 2008;7(9):1357-65. [Medline].

  2. Centers for Disease Control and Prevention. Laboratory-acquired human glanders--Maryland, May 2000. MMWR Morb Mortal Wkly Rep. Jun 23 2000;49(24):532-5. [Medline].

  3. Duplessis C, Maguire JD. Melioidosis masquerading as community-acquired pneumonia: a case report demonstrating efficacy of intrapleural fibrinolytic therapy. J Travel Med. Jan-Feb 2009;16(1):74-7. [Medline].

  4. Overtoom R, Khieu V, Hem S, Cavailler P, Te V, Chan S, et al. A first report of pulmonary melioidosis in Cambodia. Trans R Soc Trop Med Hyg. Dec 2008;102 Suppl 1:S21-5. [Medline].

  5. Valsalan R, Seshadri S, Pandit VR. Melioidosis masquerading as enteric fever. Trans R Soc Trop Med Hyg. Dec 2008;102 Suppl 1:S117-8. [Medline].

  6. Mukhopadhyay C, Chawla K, Krishna S, Nagalakshmi N, Rao SP, Bairy I. Emergence of Burkholderia pseudomallei and pandrug-resistant non-fermenters from southern Karnataka, India. Trans R Soc Trop Med Hyg. Dec 2008;102 Suppl 1:S12-7. [Medline].

  7. Montgomery S. Burkholderia pseudomallei (melioidosis) Attack. In: Ciottone GR, Anderson PD, Auf Der Heide E, Darling RG, Jacoby I, Noji E, Suner S, eds. Disaster Medicine. 3rd ed. Philadelphia, PA: Mosby/Elsevier; 2006:chap 115; 650-652.

  8. Muttarak M, Peh WC, Euathrongchit J, Lin SE, Tan AG, Lerttumnongtum P, et al. Spectrum of imaging findings in melioidosis. Br J Radiol. Dec 19 2008;[Medline].

  9. Dance DA. Melioidosis as an emerging global problem. Acta Trop. Feb 5 2000;74(2-3):115-9. [Medline].

  10. Graber MA. Burkholderia mallei (glanders) attack. In: Ciottone GR, Anderson PD, Auf Der Heide E, Darling RG, Jacoby I, Noji E, Suner S, eds. Disaster Medicine. 3rd ed. Philadelphia, PA: Mosby/Elsevier; 2006:chap 114; 647-649.

  11. CIDRAP News. US awards contracts in hunt for versatile biodefense drug. September 23, 2008. CIDRAP, Center for Infectious Disease Research & Policy. Available at http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/sep2308contracts-jw.html. Accessed February 22, 2009.

  12. Goodyear A, Kellihan L, Bielefeldt-Ohmann H, Troyer R, Propst K, Dow S. Protection From Pneumonic Burkholderia Infection by Inhalational Immunotherapy. Infect Immun. Jan 29 2009;[Medline].

  13. Sarkar-Tyson M, Titball RW. Progress toward development of vaccines against melioidosis: A review. Clin Ther. Aug 2010;32(8):1437-45. [Medline].

  14. CDC Strategic Planning Workgroup. Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup. MMWR Recomm Rep. Apr 21 2000;49(RR-4):1-14. [Medline].

  15. Centers for Disease Control and Prevention. Imported melioidosis--South Florida, 2005. MMWR Morb Mortal Wkly Rep. Aug 18 2006;55(32):873-6. [Medline].

  16. Institute for International Cooperation in Animal Biologics. Glanders. Last updated January 2004. The Center for Food Security & Public Health (Iowa State University). Available at www.cfsph.iastate.edu/Factsheets/pdfs/glanders.pdf. Accessed June 13, 2007.

  17. Institute for International Cooperation in Animal Biologics. Melioidosis. Last updated October 2005. The Center for Food Security & Public Health (Iowa State University). Available at www.cfsph.iastate.edu/Factsheets/pdfs/melioidosis.pdf. Accessed June 13, 2007.

  18. Ko WC, Cheung BM, Tang HJ, Shih HI, Lau YJ, Wang LR, et al. Melioidosis outbreak after typhoon, southern Taiwan. Emerg Infect Dis. Jun 2007;13(6):896-8. [Medline].

  19. McGovern TW, Christopher GW, Eitzen EM. Cutaneous manifestations of biological warfare and related threat agents. Arch Dermatol. Mar 1999;135(3):311-22. [Medline].

  20. Short BH. Melioidosis: an important emerging infectious disease - a military problem?. ADF Health. Apr 2002;3:13-21.

  21. Thummakul T, Wilde H, Tantawichien T. Melioidosis, an environmental and occupational hazard in Thailand. Mil Med. Sep 1999;164(9):658-62. [Medline].

  22. USAMRIID. Glanders and melioidosis. In: Biological Warfare and Terrorism: Medical Issues and Response. 2000. 21-25.

  23. USAMRIID. Glanders and Melioidosis. Accessed January 28, 2005. Available at http://navymedicine.med.navy.mil/Files/Media/directives/5042.pdf.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.