Medication
5.1.1 Adults In severe tularaemia which requires hospitalization, parenteral administration of an amino- glycoside is the irst choice for treatment. Gentamicin is preferred at 5 mg/kg daily, divided into two doses and monitored by assay of serum concentrations of the drug.
How is tularaemia treated in adults?
Ciproloxacin for treatment of tularemia in children. Pediatric Infectious Disease Journal , 19:449–453. Johansson A et al. (2000b). Comparative analysis of PCR versus culture for diagnosis of ulceroglandular tularemia. European Journal of Clinical Microbiology, 38:22–26. Johansson A et al. (2000c).
What are the treatment options for tularemia in children?
Physicians who suspect tularemia should promptly collect appropriate specimens (see below) and alert the laboratory to the need for special diagnostic and safety procedures. Rapid diagnostic testing for tularemia is not widely available.
What should a physician do if they suspect tularemia?
WHO GUIdelInes On tularaemia This irst edition of the WHO guidelines on tularaemiais the result of an international collaboration, initiated at a WHO meeting in Bath, UK in 2003. The target audience includes clinicians, laboratory personnel, public health workers, veterinarians, and any other person with an interest in zoonoses.
Where did the who guidelines on tularaemia come from?
How is tularemia treated?
Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for several weeks, most patients completely recover.
What is the standard treatment for tularemia exposure?
Tularemia can be effectively treated with antibiotics given by injection directly into a muscle or vein. The antibiotic gentamicin is typically the treatment of choice for tularemia. Streptomycin is also effective, but can be hard to get and may have more side effects than other antibiotics.
What happens if tularemia goes untreated?
Left untreated, tularemia can be fatal. Other possible complications include: Inflammation of the lungs (pneumonia). Pneumonia can lead to respiratory failure — a condition in which the lungs don't take in enough oxygen, don't release enough carbon dioxide or both.
Who is most at risk for tularemia?
Affected Populations Tularemia affects males and females, although the majority of cases are males, probably because of greater outdoor exposure opportunities. The disease is rare in the United States with approximately 100-200 new cases reported each year.
Will tularemia go away on its own?
Fever may be high, and may go away for a short time only to return. Untreated, the fever usually lasts about four weeks. Other symptoms depend on the type of tularemia. In ulceroglandular tularemia, a red nodule appears at the site of inoculation and eventually forms an open sore associated with swollen lymph nodes.
What is the prognosis of tularemia?
Prognosis for Tularemia Case fatality is almost nil in treated cases and about 6% in untreated cases of ulceroglandular tularemia. Case fatality rates are higher for type A infection and for typhoidal, septicemic, and pneumonic tularemia; they are as high as 33% for untreated cases.
Can you get tularemia twice?
If you have complications like pneumonia or meningitis, you'll also need treatment for these conditions. Usually people who have had tularemia become immune to it, but some people get it more than once.
Is tularemia and Lyme disease the same?
Though Lyme disease gets a lot of attention, it is only one of many serious tick-borne diseases – including tularemia.
How do I know if I have tularemia?
Possible symptoms include skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If the bacteria are inhaled, symptoms can include abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness.
What is the most common clinical presentation of tularemia?
Ulceroglandular This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the bacteria entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
Can you eat meat from an animal with tularemia?
Can I Eat The Meat? Meat from animals that die of tularemia should not be consumed by humans. Normal cooking temperatures will kill bacteria in the meat. Management of tularemia is not practical or feasible in wild animals.
How common is tularemia in rabbits?
Tularemia, or rabbit fever, is a bacterial disease associated with both animals and humans. Although many wild and domestic animals can be infected, the rabbit is most often involved in disease outbreaks. Tularemia is relatively rare in Illinois; five or fewer cases are reported each year. Who gets tularemia?
What is tularemia in animals?
Tularemia is a disease that can infect animals and people. Rabbits, hares, and rodents are especially susceptible and often die in large numbers during outbreaks. People can become infected in several ways, including: Tick and deer fly bites. Skin contact with infected animals. Drinking contaminated water.
Can bioterrorism cause tularemia?
Inhaling contaminated aerosols or agricultural and landscaping dust. Laboratory exposure. In addition, people could be exposed as a result of bioterrorism. Symptoms vary depending how the person was infected. Tularemia can be life-threatening, but most infections can be treated successfully with antibiotics.
What is the fatality rate of tularaemia?
Before the advent of antibiotics, the fatality rate of type A tularaemia was 5–15% and in its most severe forms as high as 30–60%. Currently, it is less than 2% (Dennis et al., 2001). High fever is accompa nied by progressive weakness, malaise, anorexia and loss of weight.
Where were the WHO guidelines developed?
The guidelines are the result of an international collaboration, initiated at a WHO meeting in Bath, United Kingdom of Great Britain and Northern Ireland in 2003, continued in Umeå, Sweden, in 2004 and inalized in Geneva, Switzerland, in 2005.
Does LVS cause tularaemia?
In addition to these studies there is evidence that the LVS vaccine has had an impact on the incidence of laboratory-acquired tularaemia. A study published by Burke in 1977 reported the incidence of laboratory-acquired tularaemia before (1950–1959) and after (1960–1969) routine immunization of workers.
Who performed secretarial work for the first time?
Excellent secretarial work was performed for the initial period by Williamina Wilson and Eglé Lorenzin, both at the World Health Organization, Geneva, Switzerland.
Is tularaemia a laboratory infection?
Due to the extremely low infectious dose, tularaemia has been one of the most commonly reported laboratory-associated bacterial infections (Pike, 1976; Centers for Disease Control and Prevention, 2000; Shapiro & Schwartz, 2002).
What level of biosafety should tularemia be performed in?
Laboratory personnel should be alerted when tularemia is suspected. Standard diagnostic procedures with clinical materials can be performed in biosafety level 2 conditions. All work with suspect cultures of tularensis should be performed in a biological safety cabinet. Manipulation of cultures and other procedures that might produce aerosols or droplets (e.g., grinding, centrifuging, or vigorous shaking) should be conducted under biosafety level 3 conditions.
Why should the laboratory be alerted if F. tularensis is suspected?
The laboratory should be alerted if F. tularensis is suspected so cultures can be incubated for extended periods , due to the fastidious, slow-growing nature of the bacterium. Seroconversion from negative to positive IgM and/or IgG antibodies in paired sera.
What is tularemia caused by?
For Clinicians. Tularemia is caused by infection with the bacteria Francisella tularensis. Naturally occurring F. tularensis infections have been reported from all states except Hawaii. Transmission routes are multiple and include tick bite, deer fly bite, inhalation, ingestion, and skin contact with infected animals.
How long after tularemia can you get serum?
Ideally, serum would be collected at least 14 days after illness onset to ensure sufficient time for development and detection of an antibody response. Note: Tularemia is rare; positive serologic tests should be interpreted in the context of a compatible clinical illness and exposure.
How to detect F. tularensis?
Detection of F. tularensis in a clinical specimen by direct immunofluorescence assay (DFA), immunohistochemical staining, or polymerase chain reaction (PCR) assay.
Can F. tularensis be isolated?
Isolation of F. tularensis from a clinical specimen; appropriate specimens include swabs or scrapings of ulcers, lymph node aspirates or biopsies, pharyngeal swabs, or respiratory specimens (e.g. pleural fluid), depending on the form of illness. Blood cultures may often be negative.
Is isolation recommended for tularemia?
Infection control and environmental decontamination. Isolation is not recommended for tularemia patients, given the lack of person-to-person transmission. In hospitals, standard precautions are recommended. Laboratory personnel should be alerted when tularemia is suspected.
What jobs can you get with tularemia?
Jobs such as laboratory worker, farmer, veterinarian, hunter, landscaper, wildlife manager, and meat handler. Living in or visiting the south-central United States. Hunting or gardening. Wild animals may be infected with tularemia, and stirring up soil may cause bacteria to be released. Diagnosis and Treatment.
How rare is tularemia?
Tularemia is rare. There were only 229 reported cases in the United States in 2018. People get it most from tick bites or contact with a contaminated animal.
How long does it take to get sick from Francisella tularensis?
If you do become sick after being exposed to Francisella tularensis, you’re likely to start having symptoms within 3 to 5 days, but it can take up to 2 weeks. There are different types of tularemia that each have their own specific symptoms. Ulceroglandular tularemia is the most common variety of the disease.
What is the most common type of tularemia?
Ulceroglandular tularemia is the most common variety of the disease. Symptoms can include:
Why is it so hard to diagnose tularemia?
It can be hard to diagnose tularemia because the symptoms can be similar to other diseases. Your doctor will test you to confirm the bacteria is present. They may also order a chest X-ray to check for signs of pneumonia.
Where can tularemia be found?
Tularemia can happen anywhere in the world, but it’s most common in rural areas where animals are more likely to be infected with the bacteria. It can survive in soil, water, and dead animals for weeks. That’s why it can cause infections in so many different ways.
Can a rabbit get tularemia?
People can become sick with tularemia, but it’s not a disease that naturally occurs in humans. It often affects rabbits and other animals including rodents, sheep, and birds. House pets like dogs and cats can get tularemia too.
How is tularemia treated?
Your doctor will most likely prescribe antibiotics, which must be taken as directed by your doctor to ensure the best possible result. Let your doctor know if you have any allergy to antibiotics.
What can I do to prevent becoming infected with tularemia?
Tularemia occurs naturally in many parts of the United States. Use insect repellent containing DEET on your skin, or treat clothing with repellent containing permethrin, to prevent insect bites. Use care and wear gloves when handling sick or dead animals. Be sure to cook your food thoroughly and that your water is from a safe source. Note any change in the behavior of your pets (especially rodents, rabbits, and hares) or livestock, and consult a veterinarian if they develop unusual symptoms.
What is tularemia?
Tularemia is a potentially serious illness that occurs naturally in the United States. It is caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares).
How do you know if you have tularemia?
These symptoms can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Top of Page.
Can tularemia be spread?
Tularemia is not known to be spread from person to person. People who have tularemia do not need to be isolated. People who have been exposed to the tularemia bacteria should be treated as soon as possible. The disease can be fatal if it is not treated with the right antibiotics. Top of Page.
Can tularemia be used as a weapon?
Francisella tularensis is very infectious. A small number (10-50 or so organisms) can cause disease. If F. tularensis were used as a weapon, the bacteria would likely be made airborne for exposure by inhalation. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.
What is the best treatment for tularaemia?
Antibiotic treatment of tularaemia is based on a few drugs, including the fluoroquinolones (e.g., ciprofloxacin), the tetracyclines (e.g., doxycycline), and the aminoglycosides (streptomycin and gentamicin). Because no effective and safe vaccine is currently available, tularaemia prophylaxis following proven exposure to F. tularensisalso relies on administration of antibiotics. A number of reasons make it necessary to search for new therapeutic alternatives: the potential toxicity of first-line drugs, especially in children and pregnant women; a high rate of treatment relapses and failures, especially for severe and/or suppurated forms of the disease; and the possible use of antibiotic-resistant strains in the context of a biological threat. This review presents novel therapeutic approaches that have been explored in recent years to improve tularaemia patients' management and prognosis. These new strategies have been evaluated in vitro, in axenic media and cell culture systems and/or in animal models. First, the activities of newly available antibiotic compounds were evaluated against F. tularensis, including tigecycline (a glycylcycline), ketolides (telithromycin and cethromycin), and fluoroquinolones (moxifloxacin, gatifloxacin, trovafloxacin and grepafloxacin). The liposome delivery of some antibiotics was evaluated. The effect of antimicrobial peptides against F. tularensiswas also considered. Other drugs were evaluated for their ability to suppress the intracellular multiplication of F. tularensis. The effects of the modulation of the innate immune response (especially via TLR receptors) on the course of F. tularensisinfection was characterized. Another approach was the administration of specific antibodies to induce passive resistance to F. tularensisinfection. All of these studies highlight the need to develop new therapeutic strategies to improve the management of patients with tularaemia. Many possibilities exist, some unexplored. Moreover, it is likely that new therapeutic alternatives that are effective against this intracellular pathogen could be, at least partially, extrapolated to other human pathogens.
Can doxycycline be used as a substitute for tetracycline?
Tetracyclines, especially doxycycline, are considered a potential alternative. However, due to its bacteriostatic activity, treatment must be administrated for a minimum of 2 weeks, and higher relapse rates have been reported as compared to fluoroquinolones (Enderlin et al., 1994). Tetracyclines are classically contraindicated in children less than 8 years old because of the risk of teeth discoloration, and in pregnant women because of foetal bone toxicity.
Is Francisella tularensis a pathogen?
Francisella tularensis, the agent of tularaemia, is a facultative intracellular pathogen of humans and hundreds of animal species (including mammals, insects, arthropods, and protozoa). It is highly infectious, with only 10 bacteria able to cause a lethal infection. Two F. tularensissubspecies are virulent for humans: subsp. tularensis(type A), found mainly in North America, and subsp. holarctica(type B), found throughout the northern hemisphere. Both subspecies are classified as category A agents of biological threat by the Centers for Disease Control (CDC, Atlanta, Georgia, USA).
Can streptomycin be used for tularaemia?
According to the WHO guidelines (WHO, 2007), patients with severe tularaemia requiring hospitalization should receive parenteral administration of streptomycin or gentamicin. Both aminoglycosides display in vitrobactericidal activity against F. tularensistypes A and B (Enderlin et al., 1994; Johansson et al., 2002; Kreizinger et al., 2013b). Aminoglycosides are associated with better outcomes and lower relapse rates (Enderlin et al., 1994). However, they can only be used parenterally, and they are occasionally associated with severe toxicity (especially ototoxicity and nephrotoxicity). Streptomycin is no longer available in many countries.
Is tularaemia a reemerging disease?
Tularaemia is considered a re-emerging disease, and recent outbreaks have been reported worldwide (Chitadze et al., 2009; Hauri et al., 2010). The mean incubation period of tularaemia is only 3–5 days (Tarnvik and Chu, 2007) and even less in case of aerosol contamination. Most clinical cases involve chronic lymphadenopathy associated with a skin, mucosa or conjunctival inoculation lesion. Less frequently, patients suffer from systemic diseases, and inhalation of infected aerosols may lead to severe pneumonia with mortality rates up to 60% (Gill and Cunha, 1997). This latter clinical form is the most feared in the context of bioterrorism. No vaccine is currently available and only a few antibiotic classes are effective to treat tularaemia patients, including the fluoroquinolones, the tetracyclines and the aminoglycosides (only streptomycin and gentamicin) (KuoLee and Chen, 2007; Hepburn and Simpson, 2008). Although no acquired resistance to these antibiotics has been described in natural strains of F. tularensis, many therapeutic failures and relapses have been reported (Perez-Castrillon et al., 2001; Kosker et al., 2013). Even with antibiotic treatment, tularaemia may be associated with 2% mortality (Evans et al., 1985). It is therefore essential to develop novel and effective preventive and curative treatments.
Generalized Signs and Symptoms
Specific Presentations
Laboratory Diagnosis
Diagnostic Considerations
Specialist to consult
Treatment
Infection Control and Environmental Decontamination
Vaccination
References