View source for Medicine:Glanders

{{Short description|Horse disease that can be transmitted to humans}}
{{Infobox medical condition (new)
| name            = Glanders
| synonyms        = Equinia, farcy,<ref name=Wilkinson/> malleus<ref name="Andrews"/>
| image           = NHR April1917 p.76.jpg
| caption         = Philadelphia horse fountain, altered to discourage spread of glanders, 1917.
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'''Glanders''' is a contagious [[Biology:Zoonosis|zoonotic]] [[Medicine:Infectious disease|infectious disease]] that occurs primarily in [[Biology:Horse|horse]]s, mules, and [[Biology:Donkey|donkey]]s. It can be contracted by other animals, such as dogs, cats, pigs, goats, and humans. It is caused by infection with the [[Biology:Bacteria|bacterium]] ''[[Biology:Burkholderia mallei|Burkholderia mallei]]''.

Glanders is endemic in Africa, Asia, the Middle East, and Central and South America. It has been eradicated from North America, Australia, and most of Europe through surveillance and destruction of affected animals and import restrictions. It has not been reported in the United States since 1945, except in 2000, when an American lab researcher had an accidental exposure in the lab.<ref name="cdc1"/> It is a [[Medicine:Notifiable disease|notifiable disease]] in the UK,<ref name="not"/> although it has not been reported there since 1928.

The term is from [[Social:Middle English|Middle English]] ''{{lang|enm|glaundres}}'' or [[Social:Old French|Old French]] ''{{lang|fro|glandres}}'', both meaning glands.<ref name="dic"/> Other terms include {{lang-la|malleus}}, {{lang-es|muermo}}, {{lang-de|Rotz}} and {{lang-no|snive}}.

==Presentation==
Signs of glanders include the formation of [[Medicine:Nodule|nodular]] [[Medicine:Lesion|lesion]]s in the lungs and [[Medicine:Ulcer|ulcer]]ation of the [[Biology:Mucous membrane|mucous membrane]]s in the [[Medicine:Respiratory tract|upper respiratory tract]]. The '''acute form''' results in coughing, fever, and the release of an infectious nasal [[Biology:Mucus|discharge]], followed by [[Medicine:Sepsis|septicaemia]] and death within days. In the '''chronic form''', nasal and [[Biology:Subcutaneous tissue|subcutaneous]] nodules develop, eventually ulcerating; death can occur within months, while survivors act as carriers.

==Cause and transmission==
[[File:Burkholderia mallei.jpg|thumb|''Burkholderia mallei'']]
Glanders is caused by infection with the  ''Burkholderia mallei'', usually by ingestion of [[Chemistry:Contamination|contaminated]] feed or water. ''B. mallei'' is able to infect humans, so it is classed as a [[Biology:Zoonosis|zoonotic]] agent. Transmission occurs by direct contact with infected animal's  body fluid and tissues and entry is through skin abrasions, nasal and oral mucosal surfaces, or inhalation.<ref>{{cite web |url=https://www.cdc.gov/glanders/transmission/index.html#:~: |title=Glanders-Transmission |website=cdc.gov.in |date=15 October 2018 |access-date=2020-09-04 |archive-date=2011-10-18 |archive-url=https://web.archive.org/web/20111018051532/https://www.cdc.gov/glanders/transmission/index.html#:~: |url-status=live }}</ref>

==Diagnosis==
The mallein test is a sensitive and specific clinical test for glanders. Mallein (ATCvet code: {{ATCvet|I05|AR01}}), a protein fraction of the glanders organism (''B. mallei''), is injected intradermopalpebrally or given by eye drop. In infected animals, the eyelid swells markedly in 1 to 2 days.

==Historical cases and potential use in war==
Glanders has been known since antiquity, with a description by Hippocrates around 425 [[Common Era|BCE]].<ref>{{cite journal |first=C. D. |last=McGilvray |title=The Transmission of Glanders from Horse to Man |journal=Canadian Journal of Public Health |publisher=Canadian Public Health Association |volume=35 |number=7 |date=July 1944 |pages=268–275 |jstor=41978893}}</ref>

From the Middle Ages to the 1900s, glanders was a significant threat to armies.<ref>{{cite book |first=E.G. |last=Lafosse |title=Traité sur le véritable siège de la morve des chevaux, et les moyens d'y remédier |location=Paris |publisher=David & Gonichon |year=1749 |chapter=Preface |quote=It is a well established fact that the great and terrible ravages of glanders are found in the armies; it is certain that during all the wars under which Europe has laboured for 200 years, a very considerable number of horses has been lost through this disease."}}</ref><ref name=Wilkinson>{{cite journal |last1=Wilkinson |first1=Lise |s2cid=4591425 |title=Glanders: Medicine and Veterinary Medicine in Common Pursuit of a Contagious Disease |journal=Medical History |date=1981 |volume=25 |issue=4 |pages=363–84 |doi=10.1017/S0025727300034876 |pmid=7038356 |pmc=1139069}}</ref> Before the Battle of Blenheim in 1704, glanders may have afflicted and greatly diminished the horses of Marshal Tallard's cavalry, helping the Duke of Marlborough win the battle.<ref>{{cite journal |title=From The Other Side Of The Hill, Blenheim, 1704 |first=D. G. |last=Chandler |journal=Journal of the Society for Army Historical Research |publisher=Society for Army Historical Research |volume=41 |number=166 |date=June 1963 |pages=79–93 |quote=However, the incurable murrain[Footnote1] this regiment contracted whilst sharing winter quarters with the French Sommeri Regiment had already put most of the troopers on their own two feet ─ and shortly afterwards this contagion spread to the whole army under the name of the "German sickness" for want of a better diagnosis. [Footnote1] This disease was probably "glanders." Eventually it affected a large part of Tallard's cavalry. The general condition of Marlborough's cavalry at the end of the long march to the Danube contrasted very favourably with the fettle of the French. |jstor=44222485}}</ref>

Glanders was a significant problem for civilian use of horses, as well. In the 18th-century veterinary hospital at the École Nationale Vétérinaire d'Alfort, glanders was the most common disease among their equine patients and the one most likely to cause death.<ref>{{cite journal |last1=Heintzman |first1=Kit |title=A cabinet of the ordinary: domesticating veterinary education, 1766–1799 |journal=The British Journal for the History of Science |volume=51 |issue=2 |pages=239–260 |date=2018 |doi=10.1017/S0007087418000274 |pmid=29665887 |s2cid=4947361}}</ref>

Due to the high mortality rate in humans and the small number of organisms required to establish infection, ''B. mallei'' is regarded as a potential [[Biology:Biological warfare|biological warfare]] or [[Social:Bioterrorism|bioterrorism]] agent, as is the closely related organism, ''B. pseudomallei'', the causative agent of [[Medicine:Melioidosis|melioidosis]]. During [[Social:World War I|World War I]], glanders was believed to have been spread deliberately by [[Place:German Empire|German]] agents to infect large numbers of [[Place:Russian Empire|Russian]] horses and mules on the Eastern Front.<ref name="Woods" /> [[Social:Bioterrorism#History|Other agents]] attempted to introduce the disease in the United States and Argentina. This had an effect on troop and supply convoys, as well as on artillery movement, which were dependent on horses and mules. Human cases in Russia increased with the infections during and after WWI. The {{wipe|Japan}}ese deliberately infected horses, civilians, and prisoners of war with ''B. mallei'' at the Unit 731 Pingfang (China) Institute and Unit 100 facilities during [[Social:World War II|World War II]]. The U.S. studied this agent as a possible biological weapon in 1943–44, but did not weaponize it. U.S. interest in glanders (agent LA) continued through the 1950s, except it had an inexplicable tendency to lose virulence in the lab, making it difficult to weaponize. Between 1982 and 1984, the [[Place:Soviet Union|Soviet Union]] allegedly used weaponized ''B. mallei'' during the [[Religion:Soviet–Afghan War|Soviet–Afghan War]].<ref name="bmc" />

==Vaccine research==
No vaccine is licensed for use in the U.S.<ref name="CDCprev" /> Infection with these bacteria results in nonspecific symptoms and can be either acute or chronic, impeding rapid diagnosis. The lack of a vaccine for either bacterium also makes them potential candidates for bioweaponization.<ref>{{Cite book |doi=10.1007/978-1-4419-1266-4_4 |chapter=Melioidosis and Glanders as Possible Biological Weapons |title=Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century |pages=99–145 |year=2009 |last1=Dance |first1=David Allan Brett |isbn=978-1-4419-1265-7}}</ref> Together, with their high rate of infectivity by aerosols and resistance to many common antibiotics, both bacteria have been classified as category B priority pathogens by the US NIH and US CDC, which has spurred a dramatic increase in interest in these microorganisms. Attempts have been made to develop vaccines for these infections, which would not only benefit military personnel, a group most likely to be targeted in an intentional release, but also individuals who may come in contact with glanders-infected animals or live in areas where melioidosis is endemic.

==References==
{{reflist|refs=
<ref name=dic>{{cite web |title=glanders |work=American Heritage Dictionary of the English Language: Fourth Edition |publisher=Bartleby.com |year=2000 |url=http://www.bartleby.com/61/18/G0141800.html |access-date=2007-05-13 |url-status=dead |archive-url=https://web.archive.org/web/20080131141251/http://www.bartleby.com/61/18/G0141800.html |archive-date=2008-01-31}}</ref>
<ref name=Andrews>{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=0}}</ref>{{rp|282}})
<ref name=not>{{cite web |title=Notifiable diseases in animals |url=https://www.gov.uk/government/collections/notifiable-diseases-in-animals |last1=Department for Environment, Food & Rural Affairs and Animal and Plant Health Agency |publisher=United Kingdom Government |access-date=8 April 2016 |archive-date=7 May 2016 |archive-url=https://web.archive.org/web/20160507142633/https://www.gov.uk/government/collections/notifiable-diseases-in-animals |url-status=live }}</ref>
<ref name=Woods>{{cite book |editor-last=Woods |editor-first=Lt. Col. Jon B. |date=April 2005 |title=USAMRIID's Medical Management of Biological Casualties Handbook |url=http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID%20BlueBook%206th%20Edition%20-%20Sep%202006.pdf |archive-url=https://web.archive.org/web/20070609104204/http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID%20BlueBook%206th%20Edition%20-%20Sep%202006.pdf |url-status=dead |archive-date=2007-06-09 |edition=6th |location=Fort Detrick, Maryland |publisher=U.S. Army Medical Institute of Infectious Diseases |pages=67}}</ref>
<ref name=cdc1>{{cite web |title=Laboratory-Acquired Human Glanders --- Maryland, May 2000 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4924a3.htm |access-date=29 November 2021 |archive-date=5 December 2021 |archive-url=https://web.archive.org/web/20211205225721/https://www.cdc.gov/mmWr/preview/mmwrhtml/mm4924a3.htm |url-status=live }}</ref>
<ref name=CDCprev>{{cite web |title=Glanders: Prevention |url=https://www.cdc.gov/glanders/prevention.html |publisher=CDC.gov |access-date=6 April 2016 |archive-date=28 March 2016 |archive-url=https://web.archive.org/web/20160328162225/http://www.cdc.gov/glanders/prevention.html |url-status=live }}</ref>
<ref name=bmc>{{cite journal |title=Glanders: an overview of infection in humans |journal=Orphanet Journal of Rare Diseases |volume=8 |pages=131 |last1=Van Zandt |first1=Kristopher E. |last2=Greer |first2=Marek T. |last3=Gelhaus |first3=H. Carl |date=September 3, 2013 |doi=10.1186/1750-1172-8-131 |pmid=24004906 |pmc=3766238 |doi-access=free }}</ref>
}}

== External links ==
* [https://www.cdc.gov/glanders/index.html CDC list of articles on glanders]
* [http://www.oie.int/wahis_2/public/wahid.php/Diseaseinformation/Diseasehome Current status of Glanders worldwide] at OIE. WAHID Interface - OIE World Animal Health Information Database
* [http://www.oie.int/en/animal-health-in-the-world/technical-disease-cards/ Disease card] {{Webarchive|url=https://web.archive.org/web/20141010141239/http://www.oie.int/en/animal-health-in-the-world/technical-disease-cards/ |date=2014-10-10 }}
* [https://web.archive.org/web/20040505105852/http://www.defra.gov.uk/animalh/diseases/notifiable/disease/glanders.htm Animal health aspects of glanders]
* [https://web.archive.org/web/20090531054317/http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/glanders.html Center for Biosecurity Agent Fact Sheet]
* [https://web.archive.org/web/20110824031509/http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=13373 Burkholderia mallei] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [https://www.niaid.nih.gov/ NIAID]
* [https://archive.today/20130130221734/http://oldvet.com/notes-on-glander-disease-in-horse/ Notes On Glander Disease in Horse]

{{Medical resources
| DiseasesDB     = 5222
| ICD10          = {{ICD10|A|24|0|a|20}}
| ICD9           = {{ICD9|024}}
| ICDO           =
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| MedlinePlus    =
| eMedicineSubj  = emerg
| eMedicineTopic = 884
| MeshID         = D005896
}}
{{Bacterial diseases}}

[[Category:Zoonotic bacterial diseases]]

{{Sourceattribution|Glanders}}