En Espaol (Spanish Version) Tularemia is a rare bacterial infection that can be deadly. Governments have studied its use as a germ-warfare weapon. As a weapon, it would be released in the air. The disease occurs naturally after exposure to infected animals or insects, or contaminated water or food. There are different types of the disease, depending on where the exposure and symptoms occur:
- Ulceroglandular, skin
- Glandular, lymph nodes
- Oculoglandular, eye
- Oropharyngeal, mouth and throat
- Intestinal, bowels
- Pneumonic , lung
- Typhoidal , system-wide disease
Francisella tularensis causes tularemia. There are two strains of the bacteria. One causes infection more easily than the other. The bacteria are normally found in small animals, such as mice and rabbits. The germs can survive for weeks in a cool, moist environment. Naturally, people can catch the disease if bitten by an infected animal, tick, or deer fly. It can occur through contact with an infected animal's tissues or contaminated water, food, or soil. The bacteria also can enter the body through the lungs, the eyes, mucous membranes, or skin. People cannot pass the infection to other people.
A risk factor is something that increases your chance of getting a disease or condition. The main risk factor for tularemia is exposure to the bacteria from:
Hunting, trapping, or butchering infected animalsWorking with infected animals or their tissueWorking in a laboratory with the bacteriaBiological terrorismEating meat from an infected animalBeing bitten by an infected mosquito or tick SymptomsSymptoms usually occur 3 to 5 days after exposure, but they can begin earlier or later. Symptoms vary depending on where the bacteria enter the body. Other factors include the amount of bacteria, its strength, and the ability of the person's immune system to fight the germs. Pneumonic symptoms: FeverChillsFatigueHeadacheBody achesSore throatCoughBurning sensation or pain in chest Ulceroglandular symptoms: Raised, red bump that continues to swellRaised area opens, drains pus, and forms an ulcerMay form a dark scabSwollen, tender lymph nodesFeverChills Glandular symptoms: Swollen, tender lymph nodes, but not sore Oculoglandular symptoms: Sensitivity to lightTearingPuffy eyelidSwelling, redness, and sores in the eyeSwollen lymph nodes Oropharyngeal symptoms: Irritated membranes in the mouthSore throatUlcers in the throat or on tonsilsSwollen lymph nodes Intestinal symptoms: FeverAbdominal painDiarrheaVomiting Typhoidal symptoms:
FeverChillsHeadacheMuscle achesPoor appetiteNauseaVomitingDiarrheaAbdominal painCough Symptoms of progression from other types: Swollen lymph nodesDifficulty breathingBleedingConfusionComaOrgan failureShockDeath Swollen Lymph Nodes 2008 Nucleus Medical Art, Inc. DiagnosisThe doctor will ask about your symptoms, medical history and possible source of exposure, and perform a physical exam. Other cases in the area may alert healthcare workers of the possibility of a bioterrorism attack. Test may include: Chest x-rayExamining body fluids using special techniques and precautionsSkin test to assess immune responseCulture of body fluids to check for bacteriaBlood test to detect antibodies to the bacteria TreatmentAntibiotics typically produce a quick response to the lung disease. The drugs are injected in a muscle or given through a vein. Later in treatment, some drugs can be given by mouth. Treatment lasts 10 to 14 days. Lymph nodes may require draining. Cases are reported to public health officials. Medications The antibiotics: Streptomycin, with or without chloramphenicolGentamicinDoxycyclineQuinolone antibiotics, such as Ciprofloxacin PreventionAntibiotics may be ordered in the event of a terrorism exposure. People may be placed on a "fever watch," receiving drugs after developing a fever or flu-like symptoms. A vaccine exists to help prevent tularemia. It only is partially effective. The vaccine is not available in the US and not recommended for the general population. It is recommended for laboratory workers who are in regular, close contact with large quantities of the organism.
Measures to prevent the disease from natural causes include: Do not handle sick or dead animals.Wear gloves, mask, and goggles if skinning or butchering.Completely cook game meats.Wear protective clothing if in areas where ticks or deer flies live.Use tick repellant.Check skin often for ticks.Do not touch a tick with your hand.Follow precautions when working in a laboratory. RESOURCES: The Center for Civilian Biodefense Studieshttp://www.fhma.com/bioterror.htm Centers for Disease Control and Prevention (CDC)http://www.cdc.gov References: AAP Red Book: Report of the Committee on Infectious Diseases . 27th ed. American Academy of Pediatrics; 2006. Cecil Textbook of Medicine . 22nd ed. WB Saunders Company; 2004. Consensus statement: tularemia as a biological weapon: medical and public health management. JAMA . 2001 Jun 6. Griffith's 5-Minute Clinical Consult . 2006 ed. Lippincott Williams & Wilkins; 2005. Principles and Practice of Infectious Diseases . 6th ed. Churchill Livingstone Inc.; 2004. Last reviewed January 2008 by David L. Horn, MD, FACPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
