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Tularemia

Tularemia (also known as "rabbit fever") is an infectious disease caused by the bacterium Francisella tularensis. The disease is endemic in North America, and parts of Europe and Asia. The primary vectors are ticks and deer flies, but the disease can also be spread through other arthropods. Rodents, rabbits, hares and ticks often serve as reservoir hosts. The disease is named after Tulare County, California. more...

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Mechanism of infection

Francisella tularensis is one of the most infective bacteria known. Fewer than ten organisms have been shown to lead to severe illness. Humans are most often infected by tick bite or through handling an infected animal. Ingesting infected water, soil, or food can also cause infection. Tularemia can be acquired by inhalation; hunters are at a higher risk for this disease because of the potential of inhaling the bacteria during the skinning process. Tularemia is not spread directly from person to person.

Francisella tularensis is an intracellular bacterium, meaning that it is able to live as a parasite within host cells. It primarily infects macrophages, a type of white blood cell. It is thus able to evade the immune system. The course of disease involves spread of the organism to multiple organ systems, including the lungs, liver, spleen, and lymphatic system. The course of disease is similar regardless of the route of exposure. Mortality in untreated patients can be as high as 30%, but the disease responds well to antibiotics. The exact cause of death is unclear, but it is thought be a combination of multiple organ system failures.

Incubation period

A patient with tularemia will most often develop flu-like symptoms between 1-14 days after infection (most likely 3-5 days.) If the patient was infected through an insect or tick bite, an eschar may develop at the bite site.

Treatment

The drug of choice is Streptomycin. Tularemia can also be treated with gentamicin, tetracycline or fluoroquinolone antibiotics.

Tularemia has been identified as a potential bioweapon by the Centers for Disease Control and Prevention (CDC). Because of its ability to be aerosolized and the extremely small number of bacteria needed to cause infection, it could be used against a dense urban population.

No vaccine is currently available to the general public. The best way to prevent tularemia infection is to wear rubber gloves when handling or skinning rodents (especially rabbits), avoid ingesting uncooked wild game and untreated water sources, and wearing long-sleeved clothes and using a insect repellant to prevent tick bites.

In summer 2000, an outbreak of tularemia in Martha's Vineyard resulted in one fatality, and brought the interest of the CDC as a potential investigative ground for aerosolized Francisella tularensis. Over the following summers, Martha's Vineyard was identified as the only place in the world where documented cases of tularemia resulted from lawn mowing. The research may prove valuable in preventing bioterrorism.

In 2004, three researchers at Boston University Medical Center were accidentally infected with tularemia, after apparently failing to follow safety procedures.

Read more at Wikipedia.org


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Outbreak of tularemia among commercially distributed prairie dogs, 2002 - Public Health Dispatch - Brief Article
From Morbidity and Mortality Weekly Report, 8/9/02

Tularemia has been identified recently as the cause of a die-off in captured wild prairie dogs (Cynomys Zudovicianus) (Figure) at a commercial exotic animal distributor in Texas. The Texas Department of Health and CDC immediately notified all state health departments and are investigating the outbreak.

Until shipments were halted on August 1, 2002, approximately 250 of an estimated 3,600 prairie dogs that passed through the Texas facility had died. The sick animals were believed to be part of a single shipment of prairie dogs that were caught in South Dakota starting on May 18 and shipped to the Texas distributor on June 16. All prairie dogs that were shipped by the Texas facility after June 16 or by the South Dakota trader after May 18 are being recalled.

Potentially infected prairie dogs were distributed to wholesalers, retailers, and persons in Arkansas, Florida, Illinois, Michigan, Mississippi, Nevada, Ohio, Texas, Washington, and West Virginia and exported to Belgium, the Czech Republic, Japan, The Netherlands, and Thailand. States and countries that received shipments of potentially infected animals have been notified. Unusually high numbers of sick or dead prairie dogs were reported from Texas and the Czech Republic.

Tularemia is caused by infection with Francisella tularensis. The incubation time in humans is normally 2-6 days but can be 1-14 days. The disease usually begins suddenly with high fever, chills, head and muscle aches, and a feeling of weakness. Chest discomfort and a dry cough are common. Other symptoms might appear depending on how the infection is acquired. For example, if the bacteria enter through a break in the skin, an ulcer will usually develop at the site of entry, accompanied by regional lymphadenopathy. In the United States, humans usually acquire tularemia by handling wild rabbits (e.g., while skinning the animal) or by being bitten by infective ticks and certain flies (e.g., deer flies and horse flies). Two known F tularensis biotypes exist in the United States. Type A is more virulent than type B, but both can result in severe and sometimes fatal illness. F tularensis recovered from the sick prairie dogs was type B.

Adults who have handled sick or dead prairie dogs from the suspected shipments in the last 2 weeks are being advised to take doxycycline (100 mg twice daily for 14 days) or ciprofloxacin (500 mg twice daily for 14 days). Because these drugs have a higher risk for side effects in children, children who are considered at risk should not take antibiotics but have their temperature monitored for 14 days. Persons who have been in contact with prairie dogs during the preceding 2 weeks and who have fever and other symptoms suggesting tularemia should see their physician. Preferred drugs for treatment of tularemia are gentamicin and streptomycin.

To report human tularemia cases that might be associated with prairie dog exposure or to inquire about shipment of potentially infected prairie dogs, state health departments should contact CDC's Division of Vector-borne Infectious Diseases, telephone 970-221-6400, fax 970-221-6476, e-mail ncidprairiedoginquiries@cdc.gov.

Reported by: C Lindley DVM, S Avashia, MD, K Hendricks, MD, J Rawlings, MD, J Buck, Texas Dept of Health. J Kool MD, K Gage, PhD, M Schriefer, PhD, D Dennis, MD, M Chu, PhD, Div n/Vector-borne Infectious Diseases; J Peterson, PhD, J Montenieri, D Kim, MD, T Demarcus, M Cetron, MD, Div of Global Migration and Quarantine, National Center for Infectious Diseases, CDC.

COPYRIGHT 2002 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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