Inhalational tularemia

Caution Tularemia has long been a weapon of war used and/or studied by the Japanese, the Russians, and the United States. Chemoprophylaxis is not recommended following potential natural exposures (tick bite, and/or rabbit or other animal exposures). Inhalation tularemia can lead to fulminant pneumonia with a case fatality rate of 30 to 60 percent without treatment. 

Inhalational tularemia. Inhalation of F. tularensis causes an abrupt onset of an acute, nonspecific febrile illness beginning 3-5 days after exposure, with pleuropneumonitis developing in a substantial proportion of cases during subsequent days.7... 

Tularemia is extremely infectious in aerosol form. Laboratory personnel have contracted inhalational tularemia simply by examining an open culture plate. Biosafety Level 11 precautions should be used for initial evalua-... 

Without specific instructions, most hospital and commercial laboratories do not routinely test for tularemia on clinical specimens. Consequently, unless clinicians suspect tularemia and order the appropriate testing, they may miss the diagnosis, or at least delay the diagnosis of F. tularensis infection by days or weeks. Clinicians who suspect inhalational tularemia should (43) ... 

Culture of the organism is the confirmatory test for tularemia. Pharyngeal washings, sputum specimens and fasting gastric aspirates are suitable culture specimens for patients suspected of having inhalational tularemia (43). Blood cultures seldom culture positive for patients with the disease. 

The attennated vaccine does not induce complete protection against inhalational tularemia... 

Differential Diagnosis An epidemic of inhalation anthrax in its early stage with nonspecific symptoms could be confused with a number of viral, bacteria, and fungal infections. Progression over two to three days with sudden development of severe respiratory distress followed by shock and death within twenty-four to thirty-six hours in essentially all untreated cases eliminates diagnosis other than inhalation anthrax. Other diagnosis to consider would include aerosol exposure to staphylococcal enterotoxin B (SEB), plague, or tularemia pneumonia. 

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. 

Thlaremia is a nationally notifiable disease, and its significant infectivity via inhalation makes this agent a potential choice for bioterrorism. As for other Category A agents, any suspected or confirmed case of tularemia is an indication for immediate notifications of the hospital infection control officer, and local and state health departments. 

Tularemia pneumonia can result from an inhalation exposure or from hematogenous spread of the infection. An aerosol release could be expected to result in large numbers of patients experiencing systemic symptoms accompanied by signs and symptoms associated with one or more of the following conditions pharyngitis, bronchiolitis, pleuropneumonitis and hilar lymphadenitis (43). However, many people with inhalational exposure will likely develop a clinical presentation of systemic symptoms without prominent signs or symptoms of respiratory disease. 

Tularemia Low 2 to 10 days Inhalation Mouth, Animal, Vector... 

A. Characteristics. Tularemia is a zoonotic disease caused by Francisella tularensis, a gramnegative bacillus. Humans acquire the disease under natural conditions through inoculation of skin or mucous membranes with blood or tissue fluids of infected animals, or bites of infected deerflies, mosquitoes, or ticks. Less commonly, inhalation of contaminated dust, or ingestion of contaminated foods or water, may produce clinical disease. A BW attack with F. tularensis delivered by aerosol would primarily cause typhoidal tularemia, a syndrome expected to have a case fatality rate which may be higher than the 5-10% seen when the disease is acquired naturally. 

Tularemia is not contagious from human-to-human contact it is acquired through direct contact with infected animals or by inhaling aerosolized bacteria. There is no decontamination for this. 

Tularemia (francisella tularensis), also known as rabbit fever, deerfly fever, and Ohara s disease, like the plague, is a bacterial infection that can occur naturally from the bite of insects, usually ticks and deerflies. The disease can also be acquired from contact with infected rabbits, muskrats, and squirrels, ingestion of contaminated food, or inhalation of contaminated dust. Once contracted, it is not directly spread from human to human. Tularemia remains infectious in the blood for about 2 weeks and in lesions for a month. It remains ineffective in deerflies for 14 days and ticks throughout their lifetime (about 2 years). The disease can occur at anytime of the year, but is most common in the early winter during rabbit hunting season and in the summer when tick and deerfly activity is at its peak. Tularemia contracted naturally has a death rate of approximately 5%. 

Yes. It is a widespread disease of animals. Approximately 2(X) cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents. 

Depending on the route of exposure, the tularemia bacteria may cause skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, oral ulcers, or pneumonia. If the bacteria were inhaled, symptoms would include the abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. Persons with pneumonia can develop chest pain, difficulty breathing, bloody sputum, and respiratory failure. 40% or more of persons with the... 

Period of communicability For inhalation anthrax, brucellosis, botulism, or tularemia ... 

E. Tularemia. Franciseila tularensis bacteria usually cause infection by exposure to bodily fluids of Infected animals or from the bites of ticks or mosquitoes. Aerosolized bacteria can also be Inhaled. An initial focal, suppurative necrosis is followed by bacterial multiplication within macrophages and dissemination to lymph nodes, lungs, spleen, liver, and kidneys. In the lungs, the lesions progress to pneumonic consolidation and granuloma formation and can result in chronic interstitial fibrosis. 

E. Tularemia. After inhalation, victims may develop nonspecific symptoms resembling any respiratory illness, including fever, nonproductive cough. 

The United States Army Medical Research and Material Command is the IND holder for a live attenuated tularemia vaccine that appears to be effective against inhalational exposure. 

The quantity of a BW agent required to cause disease once inside a host and the level of injury that results vary widely. The bacterium that causes tularemia, Francisella tularensis, can infect humans via inhalation of fewer than 50 microbes depending on the strain, 30—60 percent of those infected who are untreated will die within 30 days. Humans can be infected by only a single... 

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