tularemia (deer fly fever, Prahvant Valley plague, rabbit fever)
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Etiology
infection with Francisella tularensis
Epidemiology
- transmitted from rodents
- through the bite of deer flies (Chrysops discalis) or ticks
- handling of infected animal or animal carcass:
- transmission via inhalation of airborne particles
- rabbits, muskrat, beavers & squirrels are important reservoirs
Clinical manifestations
- incubation period is 2-5 days
- abrupt onset of fever/chills, myalgias & respiratory symptoms
- prolonged intermittent fever
- headache, nausea, anorexia, perspiration (case report)[7]
- cutaneous ulceration
- lymphadenopathy
- swelling & suppuration of lymph nodes draining the site of infection
- may be generalized, especially if acquired handling infected animal or carcass
- bronchopneumonia
- cough (common)
- fever (common)
- chest pain (common)
- sepsis
- many patients are asymptomatic
* images (glandular tularemia)[9][10]
Laboratory
- complete blood count
- leukocyte count is normal
- Francisella tularensis serology
- 4-fold increase in titer to > 1:160
- Francisella tularensis antigen
- Francisella tularensis in isolate
- organism is not seen with gram-stain of sputum
- Francisella tularensis nucleic acid
- Francisella tularensis culture
- requires biosafety level 3 conditions[9]
- gram negative bacillus
- also see Francisella tularensis & ARUP consult[5]
Radiology
- chest X-ray:
- hilar adenopathy[4]
- lower lobe patchy infiltrates
- generally unilateral
- bilateral in 30% of patients
- pleural effusion (30%)
- computed tomography of thorax[7] (image from case report)
Differential diagnosis
Management
- streptomycin or gentamicin for severe disease
- tetracycline or doxycycline
- active against Francisella tularensis
- associated with 10% incidence of relapse
- ciprofloxacin[10]
- duration of therapy: 7-14 days
- prophylaxis with ciprofloxacin or doxycycline[4]
- vaccine:
- not highly effective
- limited supply
Notes
- potential agent of bioterrorism[6]
More general terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 500, 798
- ↑ The Sanford Guide to Antimicrobial Therapy, 29th ed., Gilbert, DN et al (editors), Antimicrobial Therapy, Inc., Hyde Park VT, 1999
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
- ↑ 5.0 5.1 ARUP Consult: Francisella tularensis - Tularemia The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/francisella-tularensis
- ↑ 6.0 6.1 Dennis DT, Inglesby TV, Henderson DA Tularemia as a biological weapon: medical and public health management. JAMA. 2001 Jun 6;285(21):2763-73 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11386933
- ↑ 7.0 7.1 7.2 Rothaus C Back to Nature. Now@NEJM http://blogs.nejm.org/now/index.php/back-to-nature/2015/12/04/
James J, Kaul DR, Goldberger ZD, Saint S, Skerrett SJ. CLINICAL PROBLEM-SOLVING. Back to Nature. N Engl J Med 2015; 373:2271-2276December 3, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26630146 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcps1407030 - ↑ Thomas LD, Schaffner W. Tularemia pneumonia. Infect Dis Clin North Am. 2010 Mar;24(1):43-55. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20171544
- ↑ 9.0 9.1 9.2 Marks L, Spec A. Glandular Tularemia. N Engl J Med 2018; 379:967. Sept 6, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30184456 https://www.nejm.org/doi/full/10.1056/NEJMicm1801531
- ↑ 10.0 10.1 10.2 Buettcher M, Imbimbo C. Images in Clinical Medicine. Ulceroglandular Tularemia N Engl J Med 2021; 384:1349. April 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33826822 https://www.nejm.org/doi/full/10.1056/NEJMicm2031676
- ↑ Yeni DK, Buyuk F, Ashraf A, Shah MSUD Tularemia: a re-emerging tick-borne infectious disease. Folia Microbiol (Praha). 2021 Feb;66(1):1-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32989563 PMCID: PMC7521936 Free PMC article.