Glanders

# Overview
Glanders (from Middle English glaundres or Old French glandres, both meaning glands) (Latin: Malleus German: Rotz) is an infectious disease that occurs primarily in horses, mules, and donkeys. It can be contracted by other animals such as dogs, cats and goats. It is caused by infection by the bacterium Burkholderia mallei, usually by ingestion of contaminated food or water. Symptoms of glanders include the formation of nodular lesions in the lungs and ulceration of the mucous membranes in the upper respiratory tract. The acute form results in coughing, fever and the release of infectious nasal discharge, followed by septicemia and death within days. In the chronic form, nasal and subcutaneous nodules develop, eventually ulcerating. Death can occur within months, while survivors act as carriers.
Glanders is endemic in Africa, Asia, the Middle East, 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.
Burkholderia mallei,  is able to infect humans and is therefore classed as a zoonotic agent. Transmission occurs by direct contact with infected animals and entry is through skin abrasions, nasal and oral mucosal surfaces, or by inhalation.

# Biological warfare use
Due to the high mortality rate in humans and the small number of organisms required to establish infection, Burkholderia mallei is regarded as a potential biological warfare (BW) or bioterrorism agent, as is the closely related organism, Burkholderia pseudomallei, the causative agent of melioidosis. During World War I, glanders was believed to have been spread deliberately by German agents to infect large numbers of Russian horses and mules on the Eastern Front. 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 Japanese deliberately infected horses, civilians, and prisoners of war with B. mallei at the Pinfang (China) Institute during World War II. The U.S. studied this agent as a possible BW weapon in 194344 but did not weaponize it. The Soviet Union is also believed to have been interested in B. mallei as a potential BW agent after World War II.

# Gallery
- Colonial morphology displayed by Gram-negative Burkholderia mallei bacteria, on a medium of sheeps blood agar (SBA). From Public Health Image Library (PHIL). 
- Colonial morphology displayed by Gram-negative Burkholderia mallei bacteria, grown on a medium of chocolate agar. From Public Health Image Library (PHIL). 
- Colonial morphology displayed by Gram-negative Burkholderia mallei bacteria, grown on a medium of chocolate agar. From Public Health Image Library (PHIL). 
- Colonial morphology colonial morphology displayed by Gram-negative Burkholderia thailandensis bacteria, grown on a medium of sheeps blood agar (SBA). From Public Health Image Library (PHIL). 

# Treatment

## Antimicrobial regimen
- Glanders
- Preferred regimen: Ceftazidime OR Gentamicin OR Imipenem OR Doxycycline OR Ciprofloxacin is recommended based on in vitro susceptibility