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Section 3. Summaries of Infectious Diseases
Tularemia
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Most patients with tularemia experience
an abrupt onset of fever, chills, myalgia, and headache. Illness
usually conforms to one of the several tularemic syndromes.
Most common is the ulceroglandular syndrome, characterized by
a painful, maculopapular lesion at the entry site, with subsequent
ulceration and slow healing associated with painful, acutely
inflamed regional lymph nodes, which can drain spontaneously.
The glandular syndrome (regional lymphadenopathy with no ulcer)
also is common. Less common disease syndromes are: oculoglandular
(severe conjunctivitis and preauricular lymphadenopathy), oropharyngeal
(severe exudative stomatitis, pharyngitis, or tonsillitis and
cervical lymphadenopathy), typhoidal (high fever, hepatomegaly,
and splenomegaly), intestinal (intestinal pain, vomiting, and
diarrhea), and pneumonic. Pneumonic tularemia, characterized
by fever, dry cough, chest pain, and hilar adenopathy, would
be the typical syndrome after intentional aerosol release of
organisms.
ETIOLOGY: Francisella tularensis, the causative agent, is a
gram-negative pleomorphic coccobacillus.
EPIDEMIOLOGY: Sources of the organism include approximately
100 species of wild mammals (eg, rabbits, hares, prairie dogs,
and muskrats, rats, voles, and other rodents); at least 9 species
of domestic animals (eg, sheep, cattle, and cats); blood-sucking
arthropods that bite these animals (eg, ticks and deerflies);
and water and soil contaminated by infected animals. In the
United States, ticks and rabbits are major sources of human
infection. Infected animals and arthropods, especially ticks,
are infective for prolonged periods; frozen rabbits can remain
infective for more than 3 years. People at risk are people with
occupational or recreational exposure to infected animals or
their habitats, such as rabbit hunters and trappers, people
exposed to certain ticks or biting insects, and laboratory technicians
working with
F tularensis, which is highly infectious and aerosolized
easily when grown in culture. In
. . . [Go to Full Text]
Related text in Red Book:
- Prevention of Tickborne Infections
Red Book
2006: 195-197.
[Extract]
[Full Version]
- Introduction
Red Book
2006: 735.
[Extract]
[Full Version]
This topic has been referenced by these articles:
- Patt, H. A., Feigin, R. D.
(2002). Diagnosis and Management of Suspected Cases of Bioterrorism: A Pediatric Perspective. Pediatrics
109: 685-692
[Abstract]
[Full Version]
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