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Tularemia:
Overview for Health Care Providers
One page summary of:
Organism/stability, Infective dose, Natural reservoir,
Route of infection, Communicability, Risk factors, Case
fatality, Incubation period, Clinical manifestations,
Laboratory tests
Tularemia: Guidance
for Health Care Providers
Key Medical and Public Health Interventions After Identification
of a Suspected Case
What is tularemia?
Tularemia is a bacterial disease that can cause a variety of symptoms,
depending on how the organism enters the body. The organism that
causes the disease is found in the environment, in wild animals,
and in arthropods (e.g., ticks and deer flies in the U.S. and mosquitoes
in other countries). Tularemia is not common in Virginia.
Who gets tularemia?
Any person can get tularemia, but it is seen most often in adults
in early winter during rabbit hunting season and in children during
the summer when there are a lot of ticks and flies. If several cases
of tularemia are diagnosed in an area, the public health department
begins an investigation to find out the source of exposure.
How is tularemia spread?
Tularemia cannot be spread from one person to another. However,
you can get the disease in a variety of ways. The skin, eye, mouth
and throat of hunters may be exposed to the bacteria while skinning
or dressing wild animals, especially rabbits or hares. Handling
or eating uncooked meat from infected animals, handling pelts and
paws of animals, drinking contaminated water, or bites of certain
arthropods may also transmit the disease. Another possible, but
rare, route of exposure is by inhaling infected aerosols, such as
dust from contaminated soil, hay or grain.
Could tularemia be used for bioterrorism?
Yes. Tularemia is one of the agents that could be used for bioterrorism
because it is highly infectious, would be easy to distribute, and
would cause many people to become seriously ill or die. Release
of tularemia as a bioterrorism agent would probably be in the form
of an aerosol.
What are the symptoms of tularemia?
Depending on the route of exposure, tularemia may cause skin ulcers,
swollen and painful lymph glands, inflamed eyes, sore throat, oral
ulcers or pneumonia-like illness. Early symptoms almost always include
the abrupt onset of fever, chills, headache, muscle aches, joint
pain, dry cough and progressive weakness. Pneumonia may be a complication
of all types of infection and requires prompt diagnosis and specific
treatment to prevent death.
How soon after exposure do symptoms
appear?
The symptoms may appear anywhere from 1 to 14 days after exposure,
but generally occur 3 to 5 days after exposure.
How is it diagnosed and treated?
Tularemia is diagnosed through special laboratory tests. Samples
may be taken from different areas, depending on the type of tularemia.
Early treatment with an antibiotic is recommended. The mortality
rate for most naturally transmitted cases of tularemia is low. Tularemia
is more dangerous when it is inhaled.
How can tularemia be prevented?
A vaccine for tularemia is currently under review by the Food and Drug Administration. If you suspect you have been exposed to tularemia, contact your doctor immediately.