Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-5 – Tularemia ( Francisella tularensis )

TULAREMIA (FRANCISELLA TULARENSIS) OVERVIEW

Any suspected or confirmed case of tularemia ( Francisella tularensis ) must be reported to the infection control practitioner [ insert telephone number ] and the local health department [ insert telephone number ] immediately .

Naturally Occurring Tularemia Tularemia, also know as rabbit fever and deer fly fever, is a zoonotic disease typically acquired by humans after skin or mucous membrane contact with infected animals. Ticks, deer flies and mosquitoes can also transmit the infection. Less commonly, inhalation of contaminated dust or ingestion of contaminated food or water may result in clinical disease. Bioterrorism Epidemiology Exposure to as few as 10 – 50 aerosolized organisms may result in clinical disease. Person to person transmission does not occur. Large numbers of temporally clustered persons presenting to a clinic or an emergency room with similar symptoms should be reported to the local health officer immediately. Incubation Period The average incubation period is 3 – 5 days (range 1 – 21 days). Clinical Presentation Tularemia may present as one of six indistinct, overlapping clinical syndromes: pneumonic, systemic, ulceroglandular, glandular, oculoglandular, and oropharyngeal. The symptoms range from asymptomatic to acute sepsis leading to rapid death. Pneumonic tularemia Pneumonic tularemia would presumably be the most likely clinical presentation of an intentional bioaerosol release of F. tularensis . The onset of symptoms may be abrupt and include: ? Fever, non- to minimally productive cough, substernal tightness, pleuritic chest pain, occasional hemoptysis (rare), chills, headache, malaise, anorexia, and fatigue ? Chest x-ray (CXR) may show infiltrates without symptoms. Other CXR findings may include subsegmental/lobar infiltrates, hilar adenopathy, pleural effusion, or miliary infiltrates (may mimic tuberculosis) ? Pleural fluid is usually exudative with more than 1000 leukocytes/mm 3

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