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:

• Ulceroglandular, skin

• Glandular, lymph nodes

• Oculoglandular, eye

• Oropharyngeal, mouth and throat

• Intestinal, bowels

• Pneumonic, lung

• Typhoidal, system-wide disease

Causes

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.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for tularemia include:

Exposure to the bacteria

• 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. 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:

• Fever

• Chills

• Fatigue

• Headache

• Body aches

• Sore throat

• Cough

• Burning sensation or pain in chest

Ulceroglandular symptoms:

• 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:

• Swollen, tender lymph nodes, but no sore

Oculoglandular symptoms:

• Sensitivity to light

• Tearing

• Puffy eyelid

• Swelling, redness, and sores in the eye

• Swollen lymph nodes

Oropharyngeal symptoms:

• 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:

• 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

Diagnosis

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:

• Chest x-ray

• Examining body fluids using special techniques and precautions

• Skin test to assess immune response

• Culture of body fluids to check for bacteria

• Blood test to detect antibodies to the bacteria

Treatment

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 10-14 days. Lymph nodes may require draining. Cases are reported to public health officials.

Prevention

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:

• Do not handle sick or dead animals.

• Wear gloves, mask, and goggles if skinning or butchering.

• Completely cook game meats.

• Wear protective clothing if in areas where ticks or deer flies live.

• 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 Civilian Biodefense Studies
http://www.fhma.com/bioterror.htm

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

References:

AAP 2000 Red Book: Report of the Committee on Infectious Diseases, 27th ed. American Academy of Pediatrics; 2006.

AAP 2000 Red Book: Report of the Committee on Infectious Diseases, 25th ed. American Academy of Pediatrics; 2000.

Cecil Textbook of Medicine, 22nd ed. WB Saunders Company; 2004.

Cecil Textbook of Medicine, 21st ed. WB Saunders Company; 2000.

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.

Griffith's 5-Minute Clinical Consult, 2001 ed. Lippincott Williams & Wilkins; 2001.

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

Principles and Practice of Infectious Diseases, 5th ed. Churchill Livingstone Inc.; 2000.