Emergency Preparedness

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

TULAREMIA – QUICK REFERENCE

Bioterrorism Epidemiology: ? Exposure to 10 – 50 organisms can result in clinical disease. ? Pneumonic tularemia is not transmitted from person to person. ? Laboratory personnel are at high risk for infection. Incubation Period: ? Average 3 to 5 days (range 1 to 21 days). Clinical Disease: (Six classic forms of tularemia that may overlap) ? Pneumonic (most likely presentation): abrupt onset of fever, chills, headache, malaise, anorexia, cough (little or no sputum production), myalgias, pleuritic chest pain, substernal tightness, and rarely hemoptysis. Pneumonia may be primary or secondary to bacteremic dissemination from other tularemia syndromes. ? Systemic: fever, chills, myalgias, sore throat, nausea, anorexia, vomiting, abdominal pain, and loose or watery diarrhea. ? Oropharyngeal, ulceroglandular, oculoglandular or glandular – (See tularemia overview). Diagnosis: ? Laboratory: elevated WBC, lactic acid dehydrogenase, serum transaminase, alkaline phosphatase, and possibly serum creatine kinase and urinary myoglobin levels. Pleural fluid generally exudative with >1000 leukocytes/mm 3. ? Radiology: Chest x-ray may show infiltrates without symptoms; subsegmental/lobar infiltrates, hilar adenopathy, pleural effusion, granulomas, or miliary infiltrates (may mimic tuberculosis). Treatment: (See overview) ? Gentamicin, Ciprofloxacin, or Doxycycline Prophylaxis: (See overview) ? Doxycycline (may substitute tetracycline) or Ciprofloxacin Isolation: ? StandardPrecautions 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.

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