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Tularemia

(Rabbit Fever; Deer-Fly Fever)

Definition

Tularemia is a rare bacterial infection. The effects of the infection will depend on where the exposure occurs. It can be deadly if not treated.

Causes

Tularemia is caused by specific bacteria. It is normally found in small animals, such as mice and rabbits. The bacteria can pass to humans through:
  • Bites of infected animals, ticks, or deer flies.
  • Contact with an infected animal's tissues or contaminated water, food, or soil. Can enter the body through the lungs, eyes, mouth, nose, or skin.
The infection does not pass between people.

Risk Factors

Factors that increase your risk of tularemia include:
  • Hunting, trapping, or butchering infected animals
  • Working with infected animals or their tissue
  • Working in a laboratory with the bacteria
  • Biological terrorism
  • Eating meat from an infected animal
  • Being bitten by an infected mosquito or tick

Symptoms

Symptoms usually occur 3-5 days after exposure. The symptoms will depend on where the bacteria entered the body, the type and amount of bacteria you were exposed to, and your immune system.
Pneumonic symptoms (lung problems):
  • Fever
  • Chills
  • Fatigue
  • Headache
  • Body aches
  • Sore throat
  • Cough
  • Burning sensation or pain in chest
Ulceroglandular symptoms (skin and lymph gland problems):
  • Raised, red bump that continues to swell
  • Raised area opens, drains pus, and forms an ulcer
  • May form a dark scab
  • Swollen, tender lymph nodes
  • Fever
  • Chills
Glandular symptoms (problems in lymph nodes):
  • Swollen, tender lymph nodes, but not sore
Oculoglandular symptoms (problems in eyes and lymph nodes):
  • Sensitivity to light
  • Tearing
  • Puffy eyelid
  • Swelling, redness, and sores in the eye
  • Swollen lymph nodes
Oropharyngeal symptoms (mouth and throat problems):
  • Irritated membranes in the mouth
  • Sore throat
  • Ulcers in the throat or on tonsils
  • Swollen lymph nodes
Intestinal symptoms:
  • Fever
  • Abdominal pain
  • Diarrhea
  • Vomiting
Typhoidal symptoms (full body problems):
  • Fever
  • Chills
  • Headache
  • Muscle aches
  • Poor appetite
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Cough
Symptoms of progression from other types:
  • Swollen lymph nodes
  • Difficulty breathing
  • Bleeding
  • Confusion
  • Coma
  • Organ failure
  • Shock
  • Death
Swollen Lymph Nodes
Swollen Lymph Nodes
Copyright © Nucleus Medical Media, Inc.

Diagnosis

The doctor will ask about your symptoms and medical history. You will be asked about possible sources of exposure. A physical exam will also be done.
Your doctor may look for signs of the infection through:
  • Examining body fluids
  • Culture of body fluids—to check for bacteria
  • Skin test to check for an immune response
  • Blood test—to detect antibodies to the bacteria
A chest x-ray may also be done if there are problems with your lungs.

Treatment

Antibiotics can treat most tularemia infections. The first few doses of antibiotics will be injected in a muscle or given through a vein. You may need to take antibiotics by mouth for a few days after the initial dose. Treatment can last for 10-14 days. Make sure to take all of your medication even if you feel better.
Tularemia infections are reported to public health officials. This will help them track any outbreaks.

Prevention

Measures to prevent the disease include:
  • Do not handle sick or dead animals.
  • Wear gloves, mask, and goggles if skinning or butchering animals.
  • Completely cook game meats.
  • Take precautions if you live in an area with ticks or deer flies:
    • Wear protective clothing.
    • Use tick repellant.
    • Check skin often for ticks.
    • Do not touch a tick with your hand.
  • Follow precautions when working in a laboratory.

RESOURCES

The Center for Biosecurity of UPMC http://www.upmc-biosecurity.org

Centers for Disease Control and Prevention (CDC) http://www.cdc.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca/

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.

Centers for Disease Control and Prevention (CDC) website. Available at: http://emergency.cdc.gov/agent/tularemia/. Updated January 11, 2011. Accessed November 12, 2012.

Griffith's 5-Minute Clinical Consult. 2006 ed. Lippincott Williams & Wilkins; 2005.

Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone Inc.; 2004.

Tularemia. Illinois Department of Public Health website. Available at: http://www.idph.state.il.us/public/hb/hbtulare.htm. Accessed November 12, 2012.

Tularemia. US Army Center for Health Promotion and preventive Medicine website. Available at: http://phc.amedd.army.mil/PHC%20Resource%20Library/18-006-0406-Tularemia-JusttheFactsApril2006.pdf. Updated April 2006. Accessed November 12, 2012.

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