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Tularemia

Tularemia is an infection common in wild rodents. It is passed to humans through contact with tissue from the infected animal. It can also be passed by ticks, biting flies, and mosquitoes.

Causes

Tularemia is caused by the bacterium Francisella tularensis.

Humans can get the disease through:

  • A bite from an infected tick, horsefly, or mosquito
  • Breathing in infected dirt or plant material
  • Direct contact, through a break in the skin, with an infected animal or its dead body (most often a rabbit, muskrat, beaver, or squirrel)
  • Eating infected meat (rare)

The disorder most commonly occurs in North America and parts of Europe and Asia. In the US, this disease is found more often in Missouri, South Dakota, Oklahoma and Arkansas. Although outbreaks can occur in the United States, they are rare.

Some people may develop pneumonia after breathing in infected dirt or plant material. This is known to occur on Martha's Vineyard, where bacteria are present in rabbits, raccoons, and skunks.

Symptoms

Symptoms develop 3 to 5 days after exposure. The illness usually starts suddenly. It may continue for several weeks after symptoms begin.

Symptoms include:

  • Chills
  • Eye irritation ( conjunctivitis -- if the infection began in the eye)
  • Fever
  • Headache
  • Joint stiffness
  • Muscle pains
  • Red spot on the skin, growing to become a sore (ulcer)
  • Shortness of breath
  • Sweating
  • Weight loss

Exams and Tests

Tests for the condition include:

This disease may also affect the results of febrile agglutinins and some tests for infectious mononucleosis.

Treatment

The goal of treatment is to cure the infection with antibiotics.

Streptomycin and tetracycline are commonly used to treat this infection. Once daily gentamicin treatment has been tried with as an alternative to streptomycin. This medicine appears to be very effective but it has been studied in only a few cases because this is a rare disease. Tetracycline and chloramphenicol can be used alone but not used as a first choice.

Note: Oral tetracycline is usually not prescribed for children until after all their permanent teeth have come in. It can permanently discolor teeth that are still forming.

Outlook (Prognosis)

Tularemia is fatal in about 5% of untreated cases, and in less than 1% of treated cases.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if symptoms develop after a rodent bite, tick bite, or exposure to the flesh of a wild animal.

Prevention

Preventative measures include skinning or dressing wild animals with gloves and avoiding sick or dead animals.

Alternative Names

Deerfly fever; Rabbit fever; Pahvant Valley plague; Ohara disease; Yato-byo (Japan); Lemming fever

References

Penn RL. Francisella tularensis (Tularemia). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 7th ed. Philadelphia, PA: Saunders Elsevier; 2009:chap 227.

Schaffner W. Tularemia and other Francisella infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 319.

Update Date: 1/29/2013

Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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