Note any change in the behavior of your pets especially rodents, rabbits, and hares or livestock, and consult a veterinarian if they develop unusual symptoms. Francisella tularensis is very infectious. A small number or so organisms can cause disease. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.
The CDC operates a national program for bioterrorism preparedness and response that incorporates a broad range of public health partnerships.
Other things CDC is doing include:. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Emergency Preparedness and Response. Section Navigation. Facebook Twitter LinkedIn Syndicate. Key Facts About Tularemia. Minus Related Pages. What is Tularemia? What are the Symptoms of Tularemia?
Known also as "rabbit fever" and "deer fly fever," tularemia was first described in the United States in and has been reported from all states except Hawaii. Tularemia was removed from the list of nationally notifiable diseases in , but increased concern about potential use of F. This report summarizes tularemia cases reported to CDC during , which indicate a low level of natural transmission.
Understanding the epidemiology of tularemia in the United States enables clinicians and public health practitioners to recognize unusual patterns of disease occurrence that might signal an outbreak or a bioterrorism event. Tularemia characteristically presents as an acute febrile illness. Various clinical manifestations can occur depending on the route of infection and host response, including an ulcer at the site of cutaneous or mucous membrane inoculation Figure 1 , pharyngitis, ocular lesions, regional lymphadenopathy, and pneumonia.
A diagnosis of tularemia can be laboratory-confirmed by culture of F. Presumptive diagnosis can be made by detecting F. For purposes of national surveillance, confirmed and probable tularemia cases are defined as clinically compatible illness with confirmatory or presumptive laboratory evidence of F.
Before September , because of ambiguity in the case definition, some cases of tularemia might have been considered confirmed by fluorescent assay alone. Case status is determined at the state level.
For the purposes of this report, any case reported to CDC was assumed to have laboratory evidence of infection. Similar results were obtained when the analysis was limited to cases with documented confirmed or probable status. The number of cases reported annually did not decrease substantially during the lapse in status as a notifiable disease during , but an increase in reporting occurred during , when notifiable status was restored.
County of residence was available for 1, reported cases. Among the 3, U. The counties with the highest number of reported cases were located throughout Arkansas and Missouri, in the eastern parts of Oklahoma and Kansas, in southern South Dakota and Montana, and in Dukes County, Massachusetts the island of Martha's Vineyard Figure 2. Males had a higher incidence in all age categories. Editorial Note: The number of tularemia cases reported annually has decreased substantially since the first half of the s.
The incidence was highest in , when 2, cases were reported 2 and remained high throughout the s. The number of cases declined substantially in the s and s to the relatively constant number of cases reported since that time.
In the United States, most persons with tularemia acquire the infection from arthropod bites, particularly tick bites, or from contact with infected mammals, particularly rabbits. Treatment with cephalothin and gentamicin was started 15 days after the onset of symptoms. Therapy with doxycycline and streptomycin was begun after documentation of the presence of antibody to Francisella tularensis. Pneumonitis worsened; disseminated intravascular coagulation and renal failure developed.
The patient died 28 days into the course of the disease. Blood cultures were positive for Francisella tularensis and treatment with gentamicin was initiated. Because of a dramatic response, gentamicin therapy was stopped after six days, but relapse occurred 17 days later. The second patient had been gravely ill, with fever, confusion, pneumonia and hepatitis. This patient did not respond to four days of treatment with gentamicin and responded only slowly after the regimen was changed to streptomycin.
Lovell et al. The patient responded to nine days of treatment with gentamicin and ampicillin. However, five days after discharge, he experienced a relapse, with tularemic meningitis. The patient was successfully treated with a two-week course of chloramphenicol.
Roy et al. The patient was treated with erythromycin and gentamicin for coverage of tularemic pneumonia and legionella infection. His respiratory status deteriorated, and the administration of gentamicin was discontinued after 24 hours. Therapy with rifampin was initiated for increased coverage of legionella pneumonia. Tularemia was later diagnosed on the basis of positive cultures, and the patient made slow but steady progress.
He was discharged during a course of treatment with doxycycline. Although no controlled studies show absolute efficacy of quinolone treatment of tularemia, there is continued evidence from Europe and Scandinavia that ciprofloxacin is a potentially valuable treatment of this disease. There are no controlled studies and little anecdotal evidence for the successful treatment of the serovar of tularemia found predominantly in the United States.
Three patients with pneumonic tularemia and one with ulceroglandular tularemia who have been successfully treated with ciprofloxacin mg twice a day Neither the severity of illness nor the presence of underlying complications was discussed. All four patients responded to treatment within 48 hours and no relapses occurred with six months.
A case of a veterinarian with ulceroglandular tularemia relapsed after treatment with doxycycline ; ciprofloxacin was given for two weeks with a successful clinical response Johansson A and colleagues reported on 12 children with ulceroglandular tularemia who were successfully treated with ciprofloxacin 29a.
Seven of these cases were culture proven with antibiotic susceptibilities demonstrating an MIC of 0. Defervescence occurred within 4 days in all patients.
Treatment was withdrawn after 3 and 7 days in two patients due to rash. All children recovered without complications. More compelling is the report in by Perez-Castrillon and colleagues on a tularemia epidemic in Northwestern Spain 45a. The treatment of Francisella tularensis biovar palaearctica infections revealed success rates of: streptomycin The types of tularemia in this epidemic included: ulceroglandular Finally, in a practice guideline on the management of patients exposed to biologic weapons published in , ciprofloxacin was listed as an alternative therapy for adults exposed to suspected tularemia Controlled trials and continued experience are necessary prior to listing quinolones in general and ciprofloxacin specifically as a treatment for tularemia especially in children and for treatment of the biovar predominant in the United States.
Four articles described six cases of tularemia in which tobramycin was used 6 , 30 , 46 , 60 Table 3. Three patients recovered and two patients died; the outcome of the remaining case was not stated. All six patients were severely ill, with complications including sepsis, diabetes, rhabdomyolysis, and renal failure.
The total duration of tobramycin therapy was not stated in four cases. Kaiser et al. The patient had symptoms suggestive of typhoidal tularemia and developed renal failure secondary to rhabdomyolysis. She was initially treated with cefazolin and tobramycin and became afebrile within 24 hours. The therapeutic regimen was changed to chloramphenicol and cefotaxime because of the need for dialysis on day six.
The patient subsequently developed disseminated intravascular coagulation and died. Provenza et al. The patient had renal insufficiency and hypertension. She was initially treated with vancomycin, tobramycin, and corticosteroids and died two days after admission. A total of 13 articles described 50 patients treated with tetracycline 7 , 8 , 15 , 26 , 33 , 35 , 38 , 40 , 45 , 50 , 54 , 61 , 62 Table 3. Forty-four patients had their infections cured, while six patients had a relapse.
Of the 44 successfully treated patients, 31 received tetracycline alone, three received tetracycline and gentamicin , and ten received tetracycline and other antibiotics not effective against tularemia. Of the six patients with relapses, two were treated with tetracycline and other antibiotics not effective against tularemia, three with tetracycline alone, and one with tetracycline and streptomycin. Caruso et al. Approximately 22 days after the onset of symptoms, therapy with tetracycline mg orally every six hours and streptomycin mg intramuscularly every 12 hours was initiated.
The duration of therapy was not stated. This patient was readmitted two months later with enlarged cervical nodes and was treated with chloramphenicol and gentamicin. The wounds stopped draining after two weeks and healed after two months; cultures were negative. Adenitis with late suppuration of regional lymph nodes has been reported in successfully treated cases, although drainage of these nodes reveals necrotic tissue that is sterile One case involved a year-old girl whose oropharyngeal tularemia was treated first with cefaclor and then with tetracycline.
She continued to have low-grade fever and tender lymph nodes, and her regimen was changed to streptomycin. Her fever responded to this therapy, but her lymphadenopathy persisted. The other case involved a year-old man with ulceroglandular tularemia who defervesced 24 hours after the start of tetracycline therapy.
Administration of the drug was inadvertently discontinued, and fever returned. After tetracycline therapy was reinitiated, the patient defervesced and his pneumonia cleared.
He later received a course of streptomycin, but further details were not given. Penn and Kinassewitz in described two patients whose infections relapsed despite tetracycline therapy.
Both patients received less than seven days of therapy and had underlying medical conditions e. A total of seven articles reported on 43 patients who received chloramphenicol 5 , 12 , 15 , 21 , 23 Table 3. Of these patients, 33 had their infections cured, one became more ill, and nine experienced a relapse. Of the 33 patients whose therapy was successful, 31 received chloramphenicol only and two received both chloramphenicol and gentamicin.
The one patient whose condition worsened and the nine patients who had relapses received chloramphenicol only. The latter patient responded to a continuation of chloramphenicol therapy. Jacobs and Narain in described four children treated with chloramphenicol. One infection was cured, but three relapsed within 72 hours of the completion of a seven to ten-day course of therapy. Parker et al. An initial oral dose of three grams was followed by doses of one gram every eight hours.
The patient was afebrile and asymptomatic after 36 hours, and therapy was discontinued after five days. On the 17th day, a relapse resulted in the initiation of a second course of treatment with chloramphenicol total, ten grams ; the patient became asymptomatic after twelve hours. Two days after the discontinuation of this second course, recrudescence was again documented. A third course of chloramphenicol 18 grams over seven days was curative.
In another case, a year-old patient with ulceroglandular tularemia presented with fever, chills, and headache. An initial dose of 3. Three days later, fever and symptoms returned.
Lee et al. No relapse was evident at a one-year follow-up examination. These nodes have typically been found to contain sterile, necrotic lymph node tissue without evidence of active infection. If untreated, symptoms of tularemia usually last one to four weeks, but may continue for months. However, the overall mortality rate for untreated tularemia is less than eight percent. Mortality is less than one percent with appropriate treatment and is often associated with long delays in diagnosis and treatment.
Following tularemia, there is usually life-long immunity Prevention of tularemia is based on avoidance of exposure to biting and blood-sucking insects Vaccination of high-risk populations who primarily work with and are exposed to large quantities of cultured organisms can be effective.
Avoidance of skinning wild animals, especially rabbits, and wearing gloves while handling animal carcasses will decrease the risk of transmission. Use of insect repellents, tick-attachment preparations, and prompt removal of ticks can be helpful.
0コメント