Symptoms How does it spread? Supportive care may include respiratory support and hydration.
Open streptomycin 7.5 to 10 mg/kg IM every 12 hours for 10 to 14 days. Isolation is not recommended, since it doesn't seem to be contagious.
A skin ulcer shows up in approximately 60% of patients and is the most common sign of tularemia. Ulcers are generally single lesions with heaped up borders 0.4-3 cm (1-3/4") in diameter.
Incubation is 1 - 21 days (generally 3 - 5 days). The onset of tularemia is usually abrupt, with fever, headache, chills and shivering, generalized body aches (especially in the low back), cold symptoms, and sore throat and unexpected severe respiratory illness in otherwise healthy people. Nausea, vomiting, and diarrhea sometimes occur. Sweats, fever and chills, progressive weakness, malaise, loss of appetite, and weight loss are to be expected.
A weapon using airborne tularemia would likely result in an outbreak of acute illness three to five days later.
If untreated, tularemia symptoms often last several weeks, sometimes, for months, usually with progressive muscle weakness. Any form of tularemia may be complicated by secondary pleuropneumonia, sepsis, and, rarely, meningitis.
Tularemia can infect humans through the skin, mucous membranes, gastrointestinal tract, and lungs. The major target organs are the lymph nodes, lungs and pleura, spleen, liver, and kidney.
Humans can become infected by various modes, including bites by infected insects, handling infectious animal tissues or fluids, direct contact with or ingestion of contaminated water, food, or soil, and inhalation of infective aerosols. Although F tularensis is highly infectious and pathogenic, its transmission from person to person has not been proven.
The organisms may also be transmitted by aerosol as a BW agent release, or by contamination of food or water supplies.
Studies of volunteers have shown that tularemia aerosol exposures can incapacitate some persons in the first day or two of illness, and significant impairment in performing tasks can continue for days after antibiotic treatment is begun.
F. tularensis can remain viable for weeks in water, soil, carcasses, hides, and for years in frozen rabbit meat. It is resistant for months to temperatures of freezing and below. It is easily killed by heat and disinfectants.
Physical findings are usually non-specific. Chest x-ray may reveal
a pneumonia. Routine culture is possible but difficult. The diagnosis
can be established retrospectively by serology.Identification
and diagnosis of tularemia using routine lab procedures could
take several weeks.
lesions should be covered and topical antibiotics applied. Prompt treatment with antibiotics is recommended with one of the following:
gentamicin 3 to 5 mg/kg IV daily for 10 to 14 days.
ciprofloxacin 400 mg IV every 12 hours, switch to oral ciprofloxacin (500 mg every 12 hours) after the patient is clinically improved; continue for completion of a 10- to 14-day course of therapy.
ciprofloxacin 750 mg orally every 12 hours for 10 to 14 days.
All food must be thoroughly heated before consumption to kill any organisms. Water must be thoroughly disinfected before consumption.
Given the short incubation period and incomplete protection of
current vaccines, vaccination is not recommended for post-exposure
prevention. A live, attenuated vaccine is available as an investigational
new drug. It's administered once by scarification. A two week
course of tetracycline is effective as prophylaxis when given
Prior to antibiotics, the overall mortality from infections was
5% - 15% and as high as 30% - 60% for untreated pneumonic and
severe systemic forms of disease. Now, the overall fatality rate
of reported cases in the U.S. is less than 2%. The less severe
strains of the disease are rarely fatal.
Without treatment, the clinical course could progress to respiratory failure, shock, and death.
USAMRIID's Medical Management of Biological Casualties Handbood; Fourth Edition February 2001; pages 9-10; http://usamriid.detrick.army.mil/education/bluebook/bluebook.pdf
Federation of American Scientists; http://www.fas.org/nuke/intro/bw/agent.htm
Virtual Naval Hospital: Treatment of Biological Warfare Agent Casualties; http://www.vnh.org/FM8284/index.html
CBS Bioterrorism Interactive; http://cbsnews.cbs.com/
All contents © 2001 Stan and Holly Deyo. All rights reserved.
This information may be used by you freely for noncommercial use only with
my name and E-mail address attached.
Holly Deyo, E-mail: firstname.lastname@example.org
How does it spread?
Supportive care may include respiratory support and hydration.
streptomycin 7.5 to 10 mg/kg IM every 12 hours for 10 to 14 days.
Isolation is not recommended, since it doesn't seem to be contagious.