Tularemia
Last Updated: 2019-08-27
ICD11: -
Last Updated: 2019-08-27
Author(s): Anzengruber F., Navarini A.
ICD11: -
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.
Especially among rural people or hunters.
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.
In addition to cephalgias, myalgia, arthralgia and febrile temperatures, symptoms are assigned to 6 different forms of manifestation.
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.
The pathogens enter through the oral mucosa, where they form aphthae.
Locoregional lymph node adenopathy
Occurrence of conjunctivitis and/or eyelid edema.
Local-regional lymph node adenopathy, mostly preauricular or submandibular.
Reduced general condition.
Diarrhea, stomach ache.
With simultaneous pneumonia also dyspnoea.
Sepsis is a complication.
Polymorphic, maculopapular exanthema or nodose erythema.
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.
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:
Alternative: Doxycycline p.o. 100 mg 2x daily
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