Tularemia

Tularemia is caused by Francisella tularensis, one of the most infectious pathogenic bacteria known. Most cases in the United States occur in south-central and western states. Humans can become infected through diverse environmental exposures, including bites by infected arthropods; handling infectious animal tissues or fluids; direct contact with or ingestion of contaminated food, water, or soil; and inhalation of infective aerosols. Inhaled F. tularensis causes pleuropneumonitis. Some exposures contaminate the eye, resulting in ocular tularemia; penetrate broken skin, result-

Figure 16-10 Dermacentorandersonitick.

(From http://www.cdc.gov/ticks/images/rocky_mountain_wood_tick.jpg.)

Figure 16-10 Dermacentorandersonitick.

(From http://www.cdc.gov/ticks/images/rocky_mountain_wood_tick.jpg.)

ing in ulceroglandular or glandular disease; or cause oro-pharyngeal disease with cervical lymphadenitis. Untreated, bacilli inoculated into skin or mucous membranes multiply, spread to regional lymph nodes, multiply further, and then can disseminate to organs throughout the body.

The onset of tularemia is usually abrupt, with fever, headache, chills and rigors, generalized body aches, coryza, and sore throat. A dry or slightly productive cough and substernal pain or tightness often occur with or without objective signs of pneumonia. Nausea, vomiting, and diarrhea can occur. Sweats, fever, chills, progressive weakness, malaise, anorexia, and weight loss characterize continuing illness. Rapid diagnostic testing for tularemia is not widely available. Respiratory secretions and blood for culture should be collected in suspected patients and the laboratory alerted to the need for special diagnostic and safety procedures. Streptomycin (1 g IM bid for 10 days) is the drug of choice, and gentamicin is an acceptable alternative. Tetracyclines and chloramphenicol can also be used.

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