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Tularemia

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Epidemiology
  • Highly infectious after aerosolization.
  • Infectious dose can be as low as 10-15 organisms.
  • Person-to-person transmission does not occur.

 

Clinical
  • Incubation period is 3-6 days with range of 1-21 days.
  • Aerosolization would most likely result in typhoidal tularemia, with pneumonic involve­ment.
  • Typhoidal tularemia is a nonspecific illness, with fever, headache, malaise and non­productive cough (mortality rates can be as high as 30-60%).
  • Diagnosis requires high index of suspicion given nonspecific presentation.

 

Laboratory Diagnosis
  • Bacterial cultures should be handled in a Biosafety Level 3 facility; isolation of organism can otherwise put laboratory workers at risk.
  • Organism is difficult to culture and grows poorly on standard media.  Cysteine-enriched media is required.
  • Serology is most commonly used for diagnosis.

 

Patient Isolation
  • Standard precautions.  Respiratory isolation not required.

 

Treatment
  • Streptomycin (7.5 mg/kg IM q 12 hours x 10-14 days) or gentamicin (3-5 mg/kg/day IV or IM qd in 3 divided doses x 10-14 days) are the preferred antibiotics.
  • Tetracyclines are alternative choices, although they are bacteriostatic and associated with higher relapse rates and must be continued for at least 14 days.

 

Prophylaxis
  • Antibiotic prophylaxis is most effective if begun within 24-hours after exposure to aerosol.
  • Tetracyclines are recommended for 14 days.
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