Tularemia

Key Info

Signs and Symptoms: Ulceroglandular tularemia presents with a local ulcer and regional lymphadenopathy, fever, chills, headache, and malaise. Typhoidal tularemia presents with fever, headache, malaise, prostration, and often substernal discomfort and a non-productive cough.

Diagnosis: Physical findings are usually non-specific. Chest x-ray may reveal a pneumonic process, mediastinal lymphadenopathy or pleural effusion. Routine culture is possible but difficult. The diagnosis can be established retrospectively by serology.

Treatment: Administration of antibiotics (streptomycin or gentamicin) with early treatment is very effective for naturally acquired disease.

Prophylaxis: A live, attenuated vaccine is available as an investigational new drug. It is administered once by scarification. A 2-week course of doxycycline or ciprofloxacin should be effective as prophylaxis when given after exposure to a susceptible strain.

Isolation and Decontamination: Standard precautions for healthcare workers. Organisms are relatively easy to render harmless by mild heat (55┬░Celsius for 10 min) and standard disinfectants.
USAMRIID's Medical Management of Biological Casualities Handbook. Sixth ed. Fort Dietrich, Maryland: U.S. Army Medical Research Institute of Infectious Diseases, 2005. 54.
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