The pulmonary form may follow inhalation or arise by hematogenous spread. Systemic symptoms as described for the septicemic form occur. The chronic form is unlikely to be present within 14 days after a BW aerosol attack. It is characterized by cutaneous and intramuscular abscesses on the legs and arms. These lesions are associated with enlargement and induration of the regional lymph channels and nodes.
Rare cases develop osteomyelitis, brain abscess, and meningitis.
Recovery from chronic glanders may occur or the disease may erupt into an acute septicemic illness. These stain irregularly with methylene blue. Cultures of autopsy nodules in septicemic cases will usually establish the presence of B. mallei . Mortality will be high despite antibiotic use. In the hamster 1 to 10 organisms administered by aerosol is lethal.