Tularemia typhoidal

Suggested Alternatives for Differential Diagnosis Brucellosis, chlamydial pneumonias, infective endocarditis, legionnaires disease, mycoplasma infections, pneumonia, Cox-iella burnetii infection, Francisella tularensis infection, Q fever, tuberculosis, tularemia, typhoid fever, and all atypical pneumonia. 

Suggested Alternatives for Differential Diagnosis Anthrax, brucellosis, dengue, ehrlichiosis, infectious mononucleosis, Kawasaki disease, leptospirosis, malaria, meningitis, men-ingococcemia, relapsing fever, Rocky Mountain spotted fever, syphilis, toxic shock syndrome, toxoplasmosis, tularemia, typhoid fever, rubella, measles. 

Tularemia Disease caused by a bacterial agent. Examples include ulceroglan-dular tularemia, glandular tularemia, typhoidal tularemia, oculoglandular tularemia, oropharyngeal tularemia, and pneumonic tularemia. 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Field First Aid Brucella is typically an acute, non-specific feverish illness with chills, sweats, headache, fatigue, myalgias, artthralgias, and anorexia (loss of appetite). Cough occurs in 15 to 25 percent of cases but a chest X-ray is usually normal. Complications may include arthritis, sacroiliitis, and vertebral osteomyelitis. Untreated disease may persist for month to years, often with relapses and remissions. Disability may be pronounced, and lethality may approach six percent. Brucellosis may be indistinguishable clinically from the typhoidal form of tularemia (see Guide For Emergency Response for Tularemia) or from typhoid fever itself. 

Signs and Symptoms Ulceroglandular tularemia presents a local ulcer and regional lymphadenopathy (any disease process affecting a lymph node or lymph nodes), fever, chills, headache, and malaise. Typhoidal or septicemic tularemia presents fever, headache, malaise, substernal discomfort, prostration, weight loss and a non-productive cough. 

Pneumonia, particularly with exposure to typhoidal tularemia... 

Ulceroglandular tularemia is the most common form. It comprises 70 to 75% of all cases. Pneumonic tularemia is the next most common (8 to 13%), followed by glandular tularemia (5 to 12%). The other forms are less common. Typhoidal tularemia has the highest mortality rate and as a result is the most likely to be used by terrorists. Exposure causes acute onset of fever, chills, headache, vomiting, and diarrhea. Skin lesions and swollen lymph nodes are not usual. This is a systemic disease and is the only form of tularemia in which diarrhea is usually seen.3... 

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 Although streptomycin is preferable, tetracyclines also are effective for both ulceroglandular and typhoidal types of tularemia. 

Tularemia is a disease caused by the bacteria Francisella tularensis. It can strike both humans and animals. Rabbits, ticks, deer-flies and many aquatic animals can transmit this disease. There are two forms of this disease ulcerograndular and typhoidal. Ulcerograndular form of this disease is more common. The initial symptom usually is a sore on the skin up to an inch across. If the disease transmits from insect bites, the sore may appear on the leg or lower part of the body, and if transmitted from an animal it may usually appear on the arm or upper part of the body. Other symptoms are enlarged lymph nodes. Ulcerogranular form of tularemia may develop after 3 to 6 days of exposure into fever, chills, cough, headache and ache in the muscles. The disease may... 

The typhoidal form of tularemia usually causes smaller lymph nodes but there is no skin sore. Both the forms of the disease can develop into pneumonia, shortness of breath and chest pain. 

Tularemia can be divided into the ulceroglan-dular (75% of patients) and the typhoidal (25% of patients) forms, based on the clinical signs. Patients with ulceroglandular tularemia have lesions on the skin or mucous membranes (including the conjunctiva), lymph nodes larger than 1 cm in diameter, or both. Patients with typhoidal tularemia, on the... 

Patients with tularemia who do not receive appropriate antibiotic treatment may have a prolonged illness characterized by malaise, weakness, weight loss, and other symptoms that last for months.22 82 84 85 Before the availability of effective antibiotics, ulceroglandular and typhoidal tularemia had mortalities of approximately 4% and 35%, respectively.44 57 With appropriate treatment, tularemia has an overall mortality of approximately 1% to 2.5%.13,86,87... 

Evidence based on an analysis of laboratory-acquired infections99 indicates that immunization with the live, attenuated LVS vaccine prevents the typhoidal and ameliorates the ulceroglandular forms of tularemia. The LVS vaccine is currently available as an Investigational New Drug from the U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland 21702-5011. 

Typhoidal tularemia Septicemia that resembles typhoid fever, caused by bacteremia from tularemia lesions. 

Humans acquire tularemia occasionally via insect vectors, such as the North American tick. In aerosolized form, typhoidal or pneumonic tularemia can be transmitted to an individual by as few as 10 to 50 organisms. Pneumonia following tularemia can kill up to 35 percent of infected individuals. However, secondary infection via breath, from one person in close proximity to another, is extremely rare. With antibiotic treatment, the mortality rate from all forms of tularemia is less than 1 percent. 

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