Comments
INITIAL SYMPTOMS:
INHALATION: Fever & tracheobronchitis; Mucopurulent discharge from nose, lips & eyes; Pneumonia; Neck & mediastinal lymphadenopathy; Pustular skin lesions; Septicemia; SKIN EXPOSURE: Suppurative skin nodules & regional lymphadenopathy; [PPID]
FINDINGS:
Localized skin infections after direct inoculation consist of ulcerating nodules with lymphangitis and lymphadenopathy. In the pulmonary form, patients have fever and pleurisy. The chest x-ray may show diffuse infiltrates, nodular densities, or lobar consolidation. The septicemic form may follow untreated lymph node infections to seed abscesses of the skin, liver, spleen, and lungs. [ID, p. 1463-4] The disease occurs in both acute and chronic forms. Findings include papules, pustules, suppurating lymph nodes, adenopathy (neck & mediastinal), abscesses (liver, lung, spleen & skin), pneumonia, and septicemia. CNS infections may occur. [PPID, p. 2550] Causes tracheobronchial necrosis; Untreated infection is fatal within 10-14 days. [Cecil, p. 1881] Direct inoculation into the eye can cause Parinaud's oculoglandular conjunctivitis. [Guerrant, p. 1005] Findings after inhalation exposure include fatigue, myalgias, pharyngitis, cough, chest pain, and cavitary lung disease. Osteomyelitis, brain abscesses, and meningitis are complications of endemic infections. [USAMRIID, p. 69-71]
EPIDEMIOLOGY:
This highly communicable disease of horses, mules, and donkeys rarely infects humans. Occupational infections occur in workers exposed to infected animals or laboratory cultures. [CCDM, p. 398] Humans become infected after contact with respiratory secretions and wound discharges from infected animals. Person-to-person transmission is possible. Only one case has been reported in the USA since 1944, and this was a worker in a biodefense laboratory. [ID, p. 1462] B. mallei bacteria live in equine hosts, not in the environment. [Harrison ID, p. 564]
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