NCJ Number
190509
Journal
MMWR Weekly Volume: 49 Issue: 24 Dated: June 23, 2000 Pages: 532-535
Date Published
June 2000
Length
4 pages
Annotation
This report summarizes the first human case of glanders in the United States since 1945.
Abstract
On May 5, 2000, the Baltimore City Health Department was notified by hospital infection-control staff of a serious systemic febrile illness in a microbiologist whose research at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) involved several pathogenic bacteria, including Burkholderia mallei, the causative agent of glanders. The microbiologist, who has insulin-requiring diabetes mellitus, experienced an increasingly painful mass in his left axilla and a temperature of 101.5 F in early March 2000. Despite completing antibiotic therapy, the episodes of fever increased, and he experienced marked fatigue, malaise, night sweats, and weight loss. A medical evaluation, which included blood and urine cultures and chest radiographs, was unrevealing. Four days after completing a 10-day course of another antibiotic, the patient’s symptoms returned and he experienced abdominal pain and continued weight loss. After hospitalization and further testing, an organism isolated from the liver abscess of the patient was identified as B. mallei. Glanders is a bacterial infection caused by the Gram-negative rod, B. mallei. Primarily a disease of equids (horses, mules, and donkeys), glanders has also been reported in carnivores that have fed on infected horse carcasses and, although rare, glanders has been reported in humans. B. mallei is being researched in the United States because it is considered a potential agent of biological terrorism. The patient reported no exposure to horses, mules, or donkeys. He did not report or recall laboratory mishaps, although on occasion he had handled without wearing gloves laboratory equipment containing live Burkholderia strains. This case raises issues concerning the ability of clinical laboratories to identify rare agents like B. mallei rapidly and accurately and the importance of considering occupational exposures among laboratory workers presenting with febrile illness. 9 references