| Disease/Syndrome |
Tularemia |
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| Category |
Infection, Occupational |
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| Acute/Chronic |
Acute-Moderate |
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| Synonyms |
Rabbit fever; Deer-fly fever; Francisella tularensis infection |
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| Biomedical References |
Search PubMed |
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| Comments |
Ulceroglandular tularemia usually presents as a skin ulcer followed by painful regional lymphadenopathy. The lymph nodes may suppurate. Lymphatic vessels may become inflamed and nodular. Ulceroglandular tularemia is to be differentiated from bubonic plague, chancroid, sporotrichosis, anthrax, and staphylococcal and streptococcal lymphadenitis. The differential diagnosis for glandular tularemia (lymphadenopathy without an ulcer) includes cat-scratch disease, tuberculosis, lymphogranuloma venereum, and bubonic plague. Hepatosplenomegaly may be found in patients with tularemia. A relative bradycardia was detected in 42% of cases in one series. Pneumonia may complicate any type of tularemia. It is common in typhoidal tularemia. Chest x-rays may show infiltrates, hilar lymphadenopathy, and pleural effusions. Mesenteric lymphadenitis and abdominal pain may follow ingestion of undercooked, infected game. [ID, p. 62, 1446-51] Fever may be recurrent. Pharyngeal tularemia is another syndrome that may be seen in outbreaks. A pharyngeal membrane was reported in a few cases. Skin rashes have been reported in up to 35% of cases and include erythema nodosum, erythema multiforme, diffuse maculopapular rash, and urticaria. Sometimes found are leukocytosis, thrombocytopenia, elevated transaminases, myoglobinuria, and pyuria. Other complications of severe disease are DIC and hepatitis. [PPID, p. 2678-81] "A nonspecific roseola-like rash may appear at any stage of the disease." [Merck Manual, p. 1475] The WBC count is usually normal, and the serum AST (SGOT) liver enzyme is commonly elevated. [Wallach, p. 933] EPIDEMIOLOGY: Reservoirs: ticks, some domestic animals, and wild animals (rabbits, voles, muskrats, beavers). Other vectors are mosquitoes (Russian Federation and Sweden) and deer flies. Drinking contaminated water is another source of infection. [CCDM, p. 573-6] Rabbits, hares, beavers, muskrats, voles, and sheep are the most common sources of infection in North America. Cats and primates have also transmitted infection. Dogs, horses, and swine may become infected. Cattle are resistant. [Zoonoses, Vol. 1, p. 275-82] Outbreaks have been reported after landscaping, mowing, and brush cutting. Farmers may become ill after handling hay contaminated with excreta of infected animals. The bacteria have been isolated from many species of birds. [ID, p. 1448] |
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| Latency/Incubation |
1 day to 2 weeks; usually 3-5 days |
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| Diagnostic |
Paired sera (4-fold rise) or a single titer >160; FA test or PCR of exudates or aspirants; Culture is hazardous, nonproductive, and done only in reference labs; [CCDM, p. 574; Lexi-ID, p. 142] |
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| ICD-9 Code |
021.9 |
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| Available Vaccine |
Yes |
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| Effective Antimicrobics |
Yes |
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| Scope |
N. America, Europe, former USSR, China, Japan [CCDM]; About 125 cases/yr reported in USA with most in AR, MO, SD, and OK; [ID, p. 1447] |
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| Reference Link |
CDC - Tularemia |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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| Job Tasks |
High risk job tasks associated with this disease:
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