Glanders caused by Burkholderia mallei is one of the oldest documented plagues of solipedes. In the times of war from Middle Ages onward and as late as World War I, losses of horses through glanders in the armed forces of several nations had a considerable devastating impact. Although the disease has been completely eradicated from North America, England, and Australia through destruction of affected and suspected animals, the disease still occurs in Pakistan, India, China, Mongolia, Brazil, Middle East, Eastern Europe, and North Africa. Veterinary laws in these countries call for destruction of affected animals. In Pakistan a low indemnity (less than a U.S. dollar) paid to the owners and lack of a rigorous implementation of the Glanders and Farcy Act, 1899 does not encourage affected animals to be destroyed. The report describes an effective glanders cure with a combination of enrofloxacin and potentiated sulphonamide (trimethoprim-sulfadiazine). All animals received both drugs intravenously for 21 days (double doses for the first week and standard doses subsequently).
An outbreak of glanders was recorded in 13 of 18 horses maintained by Faisalabad Metropolis Mounted Police in February 1999. In August, five equines (three draught horses, one mule, and a donkey) owned by private clients were also diagnosed with glanders. Four of 13 police horses suffering from glanders died before initiation of treatment. The disease was diagnosed based on clinical signs, a positive mallein reaction, and isolation of the causative agent. Intraperitoneal inoculations of guinea pigs were attended with severe orchitis, culminating in deaths after 72 hours. The glanders isolates were found sensitive to enrofloxacin and potentiated sulphonamide. The clinical signs registered in different combinations were fever, decreased appetite, dyspnoea, occasional cough, enlarged and tortuous submandibular lymph nodes, purulent nasal discharge, epistaxis, nasal septum ulcers, nodules and crater-like ulcers on different parts of the body, cording of lymphatics of hind limbs and ventral abdomen, and orchitis. Hematologic findings prior to treatment confirmed a macrocytic hypochromic anaemia.
After one week of treatment, there was a noticeable improvement in clinical condition. After completion of 14 days treatment, skin ulcers changed to scabs, and development of nodules totally ceased. Enlarged, tortuous submandibular lymph nodes and cough were still present. After completion of the third week of treatment, all animals resumed normal feed intake. Treatment was not associated with significant untoward effects except in two cases, which suffered from slight alopecia which resolved within two days after completion of therapy and a slight delirium with head shaking, quivering of breast muscle, and incoordination of gait lasting for about ten minutes. Subsequently, all animals re-checked at six and 12 months post-treatment were pronounced healthy. Two of the treated mounted police horses died after the 14th month post-treatment due to unrelated causes (i.e., severe stomach bots infestation and hindquarter oedema). Autopsies revealed a milliary calcified area in lungs devoid of any hyperaemic zone, and culturing of lung specimens was negative. Animals examined two and three years later remained healthy. Treatment of this zoonotic disease with enrofloxacin and sulpahdiazine-trimenthoprim appears to be a viable alternative in countries where a test and destruction policy cannot be implemented for socioeconomic reasons. Treatment of glanders-affected equines is also warranted on animal-welfare grounds.
Dr. M. Saqib, firstname.lastname@example.org, G. Muhammad, M. Athar, and M.H. Hussain
Department of Clinical Medicine and Surgery, Faculty of Veterinary Science, University of Agriculture, Faisalabad, 38040, Pakistan.