Glanders in a military research microbiologist.
N Engl J Med 2001 Nov; 345(22):1644
The case report by Srinivasan et al. (July 26 issue) makes one wonder when glanders was first suspected as this patient's illness. The patient's work history included potential exposure to Burkholderia mallei without personal protective equipment (gloves). Yet the patient was treated twice with agents not indicated for B. mallei infection. Once the organism was isolated, appropriate therapy was administered. When did the patient describe his occupational exposure? For researchers with occupational infections, the taking of a relevant occupational history that leads to prompt, appropriate therapy can be lifesaving. A delay in history taking and delayed specific therapy can result in prolonged illness or death. Greater attention to safety precautions by researchers and vigilance by research managers will prevent many of these types of exposure. The importance of the occupational history is well documented. Could a support system be available that would rapidly provide information regarding occupational exposure to clinicians caring for ill researchers? Some research institutions actively encourage patients to volunteer occupational information to the physician, but this will not help if the patient does not know about the exposure or is incapacitated. We need to find or develop systems to ensure that physicians receive the necessary information during the initial evaluation.
Workers; Occupational-exposure; Occupational-health; Infection-control; Worker-health; Work-analysis; Safety-measures; Physicians; Health-care-personnel
New England Journal of Medicine