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BW Agents: Tularemia

BW Agents: Tularemia. J.A. Sliman, MD, MPH LCDR MC(FS) USN Preventive Medicine Resident Johns Hopkins Bloomberg School of Public Health. Tularemia. Francisella tularensis Small, gram-negative coccobacillus

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BW Agents: Tularemia

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  1. BW Agents: Tularemia J.A. Sliman, MD, MPH LCDR MC(FS) USN Preventive Medicine Resident Johns Hopkins Bloomberg School of Public Health

  2. Tularemia • Francisella tularensis • Small, gram-negative coccobacillus • Zoonotic disease from contact with infected animals or bites from infected arthropods • Viable for weeks in soil and water, carcasses and hides

  3. Tularemia • AKA: rabbit fever or deerfly fever • Stable for years in frozen rabbit meat • Named for Tulare County, CA, where isolation work done in 1900s, and Dr. Edward Francis, USPHS, who isolated it.

  4. BW History • Easily deliverable wet or dry • First weaponized by U.S. in early 1950s • Weaponized by Former Soviet Union • 1942: several thousand Red Army and Wehrmacht troops on the Eastern Front develop pulmonic tularemia

  5. Human Disease • Normally contracted by handling contaminated animal products or excreta • Various forms are: ulceroglandular, glandular, typhoidal, oculoglandular, pharyngeal and pneumonic

  6. Human Disease • Incubation period 2 - 10 days (avg. 3 - 5) • Usually requires fewer than 50 organisms to cause disease • Most cases are ulceroglandular.

  7. Ulceroglandular tularemia • 80% of cases • Skin or mucous membrane contact with fluids of infected animal • Ulcerated skin lesion with fever, chills, headache, malaise and painful regional lymphadenopathy

  8. Ulceroglandular tularemia • Glandular type occurs without skin lesion • 5-10% of cases • Oculoglandular type presents as a painful conjunctivitis (1-2 % of cases) • Oropharyngeal form – confined to throat with acute exudative pharyngo-tonsillitis

  9. Typhoidal Tularemia • Likely form of BW attack • Occurs after inhalation, intradermal or gastrointestinal contact (usually no exposure history) • Presents with fever, prostration, & weight loss and progresses to atypical pneumonia

  10. Pneumonic tularemia • Seen in up to 80% of typhoidal cases and 15% of ulceroglandular cases • CFR(untreated) = 5% for ulceroglandular form and 35% for typhoidal form • Recovery followed by permanent immunity

  11. Diagnosis • Staining and cultures usually useless • Serology the only consistent tool • Titers peak 4 - 8 weeks after exposure • So, clinical diagnosis is the best method.

  12. Medical Management • Streptomycin 1g IV q12h f14d • Gent, tetracycline also effective • Person-to-person spread unusual • Respiratory isolation not required

  13. Medical Management • Live attenuated vaccine is available • Prophylactic therapy for likely exposures • Tetracycline 500mg po qid f14d

  14. Tularemia • Flu-like syndrome with painful regional lymphadenopathy and progressing to atypical pneumonia • Clinical diagnosis • Tetracycline 500mg po qid f2 wks

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