Tularemia

Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

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

Rabbit fever, Ohara's disease, Francisella tularensis-Infection, deer fly fever.

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

  • Rare in Europe.
  • Especially among rural people or hunters.

  • In particular <10 or >60-year-olds are affected.

  • Causative organism
    • Francisella tularensis.
    • Francisella tularensis enters the human organism through small skin lesions, mosquitoes and ticks or the GI tract.

  • Transmission: Skin or mucous membrane contact with infected animals, ingestion or transmission by mosquitoes and ticks or contaminated water.

  • Pathogen reservoirs: hare, beaver, ticks.

  • Incubation period: 2-14 days.

  • Localization
    • Especially hands..
  • In addition to cephalgias, myalgia, arthralgia and febrile temperatures, symptoms are assigned to 6 different forms of manifestation.

  • Ulzero-glandular tularaemia is the most common.
    • The pathogens are caused by skin defects.
    • The primary effect (which may be absent, but several may occur at the same time) takes the form of a small nodular blue-purple infiltrate or an ulcerated pustle.

    • Locoregional lymph node adenopathy, which often lasts for 2-3 weeks and then melts down and fistulises).
  • Mucoglandular tularaemia
    • The pathogens enter through the oral mucosa, where they form aphthae.

    • Locoregional lymph node adenopathy 

  • Oculoglandular tularaemia
    • Occurrence of conjunctivitis and/or eyelid edema.

    • Local-regional lymph node adenopathy, mostly preauricular or submandibular.

  • Typhoid tularaemia 
    • Reduced general condition.

    • Diarrhea, stomach ache.

    • With simultaneous pneumonia also dyspnoea.

    • Sepsis is a complication.

  • Allergized tularaemia 
    • Polymorphic, maculopapular exanthema or nodose erythema.

  • Medical History (contact to animals, age, place of residence).
  • Clinic.
  • Detection of pathogens (bacterial smear).

  • The serum agglutination test is positive after about the 2nd week of illness. A skin test with Francisella tularensis antigen is already positive in the first week of the disease.

  • Mediastinitis 
  • Lung abscess
  • Meningitis

  • Early therapy is important!

 

Topical Therapy

  • Antiseptic envelopes (polihexanide, potassium permanganatesg., quinolinol).

 

Systemic Therapy 

  • Streptomycin in conjunction with 0.5-1.0 g 2x daily for at least 10 days.

  • The systemic symptoms subside after 3 days - 1 week. However, the skin changes and lymph account swelling may persist for weeks.

  • Alternative: gentamicin in combination with 3 mg/kg bw daily 

  • Alternative: Tetracycline p.o. 500 mg 3x a day 

  • Alternatively: Erythromycin p.o. 500 mg 3x daily, maximum dose: 4 g/d (adults), 40-100 mg/kg bw/day (5-12 years).

  • Alternative: Ciprofloxacinp.o 500 mg 2x daily.

Exposure prophylaxis:

  • Ciprofloxacin p.o 500 mg 2x daily.
  • Alternative: Doxycycline p.o. 100 mg 2x daily

 

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