Download Burkholderia Mallei

COMMUNICABLE DISEASE MANUAL POLICIES/PROCEDURES
BURKHOLDERIA MALLEI
(GLANDERS)
OBJECTIVE:
Control and management of Glanders (animal disease and possible bioterrorism
threat).
DESCRIPTION:
Glanders is an infectious disease that is caused by the bacterium Burkholderia
mallei. Glanders is primarily a disease affecting horses, but it also affects donkeys
and mules and can be naturally contracted by goats, dogs, and cats. Human
infection, although not seen in the United States since 1945, has occurred rarely and
sporadically among laboratory workers and those in direct and prolonged contact
with infected, domestic animals.
Burkholderia mallei is an organism that is associated with infections in laboratory
workers, veterinarians, horse and donkey caretakers, abattoir workers, or any area
where the organism is being handled or where equines may be infected. Glanders
is transmitted from animals to animals and to humans by the direct contact with
infected animals. Cases of human to human transmission have been reported
through sexual transmission, close family contacts, and caregivers of patients.
Because so few organisms are required to cause disease, the organism is
considered a potential agent for biological warfare and terrorism.
Burkholderia mallei is commonly seen among domestic animals in Africa, Asia, the
Middle East, and Central and South America.
The symptoms of Burkholderia mallei (Glanders) depend upon the route of infection
with the organism. The types of infection include localized, pus-forming cutaneous
infections, pulmonary infections, bloodstream infections, and chronic suppurative
infections of the skin. Generalized symptoms of Glanders include fever, muscle
aches, chest pain, muscle tightness, and headache. Additional symptoms have
included excessive tearing of the eyes, light sensitivity, and diarrhea.
Localized infections: If there is a cut or scratch in the skin, a localized infection
with ulceration will develop within 1 to 5 days at the site where the bacteria entered
the body. Swollen lymph nodes may also be apparent. Infections involving the
mucous membranes in the eyes, nose, and respiratory tract will cause increased
mucus production from the affected sites.
Pulmonary infections: In pulmonary infections, pneumonia, pulmonary abscesses,
and pleural effusion can occur. Chest X-rays will show localized infection in the
lobes of the lungs.
Bloodstream infections: Glanders bloodstream infections are usually fatal within 7
to 10 days.
Chronic infections: The chronic form of Glanders involves multiple abscesses
within the muscles of the arms and legs or in the spleen or liver. Symptoms include
fever, malaise, pleuritic chest pain, cervical adenopathy, splenomegaly, and
generalized popular/pustular eruptions. Mortality rate is over 50% despite antibiotic
treatment.
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Burkholderia mallei is transmitted by invasion of nasal, oral, and conjunctival mucous
membranes, by inhalation into lungs, or through lacerated or abraded skin. There is
no vaccine available. In countries where Glanders is endemic in animals, prevention
of the disease in humans involves identification and elimination of the infection in the
animal population. Within the health care setting, transmission can be prevented by
using common blood and body fluid precautions.
Because human cases of Glanders are rare, there is limited information about
antibiotic treatment of the organism in humans. Sulfadiazine has been found to be
effective in experimental animals and in humans. Burkholderia mallei is usually
sensitive to tetracyclines, ciprofloxacin, streptomycin, novobiocin, gentamicin,
imipenem, ceftrazidime, and the sulfonamides. Resistance to chloramphenicol has
been reported.
EQUIPMENT:
.
POLICY:
PROCEDURE:
Disease specific form will be found in MDSS. MDCH Notification of Serious
Communicable Disease Fax if confirmed or suspect case, MDCH website at
www.michigan.gov/cdinfo
and
CDCwebsite
at
www.cdc.gov/diseasesconditions/az.
Legal Responsibility: Michigan’s communicable disease rules of Act No. 368 of the
Public Acts of 1978, as amended, being 333.5111 of the Michigan Compiled Laws.
Notify MDCH immediately via phone and fax if suspect or confirmed case and
follow-up within 24 hours post referral. ENTER INTO MDSS WITHIN 24 HOURS
OF RECEIPT OF REFERRAL.
A.
B.
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Case Investigation
1.
Referral received per phone call, laboratory results, or automatically
through MDSS.
2.
Document all case investigation proceedings in MDSS case report
form.
3.
Contact MD and/or client to start process of completing disease
specific form in MDSS.
4.
Notify CD Supervisor and Medical Director for confirmed or
suspected cases. Call MDCH at 517-335-8165 and Regional
Epidemiologist.
Nurse to Fax Notification of Serious
Communicable Disease form to MDCH for confirmed or
suspected cases.
.
Diagnosis
1.
Infection with Burkholderia mallei, the Glanders bacillus, cannot be
differentiated serologically from infection with B. pseudomallei.
2.
Culture of the isolated organism alone is needed for specific
diagnosis by Level A labs only of sputum, blood, urine, or skin
lesions.
3.
C.
D.
Control Measures
1.
Concurrent disinfection: sputum, discharges and all contaminated
articles, terminal cleaning.
2.
Use universal blood and body fluid precautions.
MDSS Case Reporting
1.
2.
3.
RESOURCES:
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Contact MDCH Lab at 517-335-8067 before obtaining or submitting
specimens. Notify MDCH Infectious Disease Section at 517-335-8165
of potential case.
Complete case investigation using disease specific form in
MDSS.
Notify CD Supervisor that the case report is ready for review.
PHN will be notified if corrections are needed prior to closing
case in MDSS.
CD Supervisor reviews case for completeness and closes
MDSS case report.
Current Red Book
Current Control of Communicable Diseases Manual
Current disease specific “Fact Sheet”
Websites: www.cdc.gov/diseasesconditions/az/a.html
www.michigan.gov/cdinfo