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:
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:
Symptoms 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:
Ulceroglandular symptoms:
Glandular symptoms:
Oculoglandular symptoms:
Oropharyngeal symptoms:
Intestinal symptoms:
Typhoidal symptoms:
Symptoms of progression from other types:
The 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:
Antibiotics 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.
The antibiotics:
Antibiotics 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:
RESOURCES:
The Center for Civilian Biodefense Studies
http://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 November 2008 by David L. Horn, MD, FACP
Please 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.
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