Tularaemia

• Chapin & Mc Coy 1912.
• Wherry & Lamb 1914.

Rabbit fever, rabbit plague, rodent disease, lemming disease, lemming fever, deer fly fever, Ohara's disease, Francisella tularensis infection, deer fly fever.

Notifiable, plague-like rodent disease caused by the gram-negative, coccoid, rod Francisella tularensis, mucoglandular tularaemia, ulcero-glandular tularaemia, oculoglandular tularaemia, typhoid tularaemia, allergic tularaemia.

• Rare in Europe.
• Mostly occurring in people from the rural population or hunters.
• In particular, <10 or >60-year-olds are affected.

• Pathogen
  • Francisella tularensis.
  • Francisella tularensis enters the human organism through small skin lesions, mosquitoes and ticks or the GI tract.
• Transmission: skin or mucosal contact with infected animals, ingestion or transmission by mosquitoes and ticks or through contaminated water.
• Pathogen reservoirs: hares, beavers, ticks.
• Incubation period: 2-14 days.

• Localisation
  • In particular hands.
• In addition to cephalgias, myalgias, arthralgias and febrile temperatures, symptoms occur which are assigned to 6 different forms of manifestation.

• Ulcero-glandular tularemia
  • Most common.
  • The causative agent enters via skin defects.
  • The primary manifestation (this may be absent, but several may occur simultaneously) is in the form of a small nodular, blue-red infiltrate or ulcerated pustule.
  • Locoregional lymph node adenopathy, which often persists for 2-3 weeks and then melts and fistulates).

• Mucoglandular tularemia
  • Entry of the causative agent via the oral mucosa, where aphthous formation occurs.
  • Locoregional lymph node adenopathy
• Oculoglandular tularemia
  • occurrence of conjunctivitis and/or eyelid oedema.
  • Locoregional lymph node adenopathy, usually preauricular or submandibular.
• Typhoid tularemia
  • Reduced general condition.
  • Diarrhoea, abdominal pain.
  • With concomitant pneumonia also dysnoea.
  • Sepsis represents a complication.
• Allergic tularemia
  • Polymorphous, maculopapular exanthema or nodular erythema.

• Anamnesis (contact with animals, age, place of residence).
• Clinical.
• Detection of pathogens (bact. smear).
• The serum agglutination test is positive from about the 2nd week of illness. A skin test with Francisella tularensis antigen is positive as early as the 1st week of illness.

• Mediastinitis
• Pulmonary abscess
• Meningitis

• Early therapy is important!

Topical therapy

• Antiseptic poultices (polihexanide, potassium permanganate solution, quinolinol).

Systemic therapy

• Streptomycin i.m. 0.5-1.0 g 2x daily for at least 10 days.
• The systemic symptoms regress after 3 days- 1 week. However, the skin changes and lymphatic swelling may persist for weeks.
• Alternative: gentamicin i.m. 3 mg/kg bw daily.
• Alternative: tetracycline p.o. 500 mg 3x daily.
• Alternative: erythromycin p.o. 500 mg 3x daily, Maximum dose: 4 g/d (adults), 40-100 mg/kg bw/day (5-12 yrs).
• Alternatively: ciprofloxacinp.o 500 mg 2x tgl.

Exposure prophylaxis:

• Ciprofloxacinp.o 500 mg 2x tgl.
• Alternatively: Doxycycline p.o. 100 mg 2x tgl.

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