CBRNE - Glanders and Melioidosis Clinical Presentation

Updated: Aug 16, 2015
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Presentation

History

Glanders is primarily zoonotic. It is transmitted to humans through direct skin or mucous membrane contact with infected animal tissues. Cases of human-to-human transmission have been reported, but no epidemics 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 the presentation of 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. [14]

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Physical

Physical findings may include fever, cervical adenopathy, hepatomegaly, or splenomegaly, and skin lesions including the following:.

  • 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.

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Causes

Glanders is primarily zoonotic. It is rare in humans, and no epidemics have been reported. Human cases of glanders have occurred primarily in occupational settings and include laboratorians, veterinarians, and animal caretakers.

Human cases of melioidosis have been transmitted via sexual contact and intravenous drug use. The disease has been observed in immigrants, military personnel, and travelers.

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