Tularemia

• 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

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3. Ulu-Kilic A , Doganay M. An overview: tularemia and travel medicine. Travel Med Infect Dis 2014;12:609-16.
4. Hamblin KA, Wong JP, Blanchard JD , Atkins HS. The potential of liposome-encapsulated ciprofloxacin as a tularemia therapy. Front Cell Infect Microbiol 2014;4:79.
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6. Penn, R. (2016). Clinical manifestations, diagnosis, and treatment of tularemia. Uptodate.com. Retrieved 24 May 2016, from http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-tularemia?source=search_result&search=tularemia&selectedTitle=1%7E62