Infectious Disease Book

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TularemiaAka: Francisella tularensis, Rabbit Fever

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  1. See Also
    1. Vector Borne Disease
    2. Prevention of Tick-borne Infection
    3. Tick Removal
  2. Epidemiology
    1. Peak onset in summer and fall
    2. Endemic areas in United States (>50% of cases)
      1. Arkansas
      2. Missouri
      3. Oklahoma
  3. Pathophysiology
    1. Francisella tularensis is causative organism
      1. Small gram-negative non-motile coccobacillus
    2. Carriers of F. tularensis
      1. Rabbits
      2. Wild rodents
      3. Tick Vector
        1. Amblyomma americanum (Lone star tick)
        2. Dermacentor variabilis (Dog tick)
    3. Transmission
      1. Tick bite (accounts for 50% of U.S. cases)
      2. Risk of exposure as Biological Weapon
    4. Incubation: 1 to 14 days
  4. Symptoms: Constitutional (follows 3-5 day incubation)
    1. Fever and chills
    2. Headache
    3. Malaise or Fatigue
    4. Anorexia
    5. Vomiting
    6. Pharyngitis
    7. Abdominal Pain
    8. Diarrhea
    9. Chest discomfort
    10. Myalgias
  5. Type Specific Signs (divided over 6 classic types)
    1. Glandular Type
      1. Localized, tender Lymphadenopathy
        1. Children: Cervical and occipital lymph nodes
        2. Adults: Inguinal lymph nodes
    2. Ulceroglandular Type (most common)
      1. Lymphadenopathy as in Glandular type
      2. Painful skin ulcer in region of Lymphadenopathy
    3. Oculoglandular Type
      1. Conjunctiva involvement
        1. Unilateral in 90% of cases
        2. Early symptoms
          1. Photophobia
          2. Increased Lacrimation
        3. Later signs
          1. Lid edema
          2. Painful Conjunctivitis
          3. Scleral injection
          4. Chemosis
          5. Small yellow Conjunctival ulcers or Papules
      2. Lymphadenopathy as in Glandular type above
        1. Preauricular, Submandibular, and Cervical nodes
    4. Pharyngeal Type
      1. Exudative Pharyngitis with severe Sore Throat
      2. Lymphadenopathy as in Glandular Type
        1. Cervical, pre-parotid and retropharyngeal nodes
    5. Typhoidal Type
      1. No significant Lymphadenopathy
      2. Profuse watery Diarrhea
    6. Pneumonic Type
      1. Non-productive cough
      2. Substernal and Pleuritic Chest Pain
      3. Infiltrates may be seen on Chest XRay
  6. Labs
    1. Inflammatory markers normal
      1. Erythrocyte Sedimentation Rate (ESR) near normal
      2. Complete Blood Count
        1. White Blood Cell count near normal
    2. Sputum or blood testing
      1. Sputum or Blood Direct fluorescent Antibody
      2. Sputum Culture or Blood Culture
    3. Tularemia Serology
      1. Confirms diagnosis at two weeks
  7. Management
    1. Treat for 10-14 days
    2. Streptomycin (not for Meningitis)
      1. Adult
        1. Initial: 7.5-10 mg/kg up to 500 mg IM q12 hours
        2. Once affebrile: 0.5 grams daily for 5 days
      2. Child: 15 mg/kg (up to 2 g) IM q12 hours
    3. Gentamicin for 7-14 days
      1. Adult: 3-5 mg/kg IM or IV qd
      2. Child: 2.5 mg/kg IM or IV q8 hours
    4. Ciprofloxacin (cartilage risk under age 18 years)
      1. Adult
        1. Initial: 400 mg IV q12 hours
        2. When Improved: 750 mg PO bid
      2. Child: 15 mg/kg (up to 500 mg) IV q12 hours
  8. Prevention
    1. Live attenuated vaccine 0.1 ml dose via scarification
      1. Awaiting FDA approval
    2. Post-exposure prophylaxis (adult dosing below)
      1. Continue for 14 days or length of exposure
      2. Doxycycline 100 mg PO bid
      3. Ciprofloxacin 500 mg PO bid
      4. Tetracycline 500 mg PO qid
  9. Prevention
    1. Live vaccine if high risk of exposure
  10. Prognosis
    1. Mortality <2%
  11. References
    1. Dennis (2001) JAMA 285(21):2763

Francisella tularensis (C0016677)

Definition (CSP)species in the family Francisellaceae; the etiologic agent of tularemia.
Definition (MSH)The etiologic agent of TULAREMIA in man and other warm-blooded animals.
ConceptsBacterium (T007)
EnglishBacterium tularense, Brucella tularensis, Francisella tularense, Francisella tularensis, Pasteurella tularensis
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Tularemia (C0041351)

Definition (MSH)A plague-like disease of rodents, transmissible to man. It is caused by FRANCISELLA TULARENSIS and is characterized by fever, chills, headache, backache, and weakness.
Definition (CSP)disease caused by Francisella tularensis and transmitted to man from rodents through the bite of a deer fly, Chrysops discalis, and other bloodsucking insects; symptoms consist of a prolonged fever and often swelling of the lymph nodes; rabbits are important reservoir hosts.
ConceptsDisease or Syndrome (T047)
ICD9021, 021.9
EnglishDeer fly fever, Deerfly fever, FRANCIS DISEASE, Francis' disease, Infection by Francisella tularensis, O'Hara's disease, OHARA DISEASE, Ohara's disease, Pahvant Valley fever, Pahvant Valley plague, Rabbit fever, Tularaemia, Tularemia, Tularemias, Tuluraemia, Tuluremia, Unspecified tularemia, Yatobyo
Spanishenfermedad de Ohara, fiebre de las moscas de los ciervos, fiebre de los conejos, fiebre del valle de Pahvant, infección por Francisella tularensis, infeccion por Francisella tularensis, peste del valle de Pahvant, tularemia, yatobyo
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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