CBRNE - Glanders and Melioidosis Follow-up

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

Deterrence/Prevention

  • Biosafety level 3 containment practices are required for laboratory staff when working with cases of glanders and melioidosis.
  • In countries where glanders is endemic in animals, identification and elimination of the disease in the animal population prevents disease in humans.
  • In areas where melioidosis is endemic, persons who have chronic illnesses that lead to an immunocompromised state should avoid contact with soil and standing water. Wearing boots and gloves during agricultural work is advised.
  • No vaccine is available for glanders.
  • No vaccine is currently approved for melioidosis. However, because of the disease's resistance to multiple antibiotics (ie, beta-lactams, aminoglycosides, macrolides, polymixins) and the frequency of relapses (13-26%), the research for a viable vaccine (eg, live-attenuated, inactivated whole cell, recombinant subunit) continues. Although live-attenuated vaccines seem to be the most effective in mice, this strategy is unlikely to be effective in humans.[13]
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Complications

  • Possible complications include septicemia, osteomyelitis, meningitis, and brain, liver, or splenic abscess.
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Prognosis

  • Untreated patients with septicemia have fatal outcomes. Before antibiotics, the death rate for septicemic disease was 95%. It is greater than 50% for septicemic disease and 20% for localized disease despite treatment. Overall, the mortality rate is 40%.
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Patient Education

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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

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  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.

 
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