Tularemia According to Walter D.

¶ … Tularemia

According to Walter D. Glanze, tularemia, "an infectious disease of animals caused by the bacillus Francisella tularensis, is often transmitted by insects or through direct contact" with the bacillus. Tularemia is also known as deerfly fever and rabbit fever (2002, p. 1204). There are generally two types or strains of the tularemia bacillus, F. tularensis "the primary type found in North America" which is highly virulent and can result in serious illness and infection in human beings, and biovar palearctica which is less virulent and produces milder symptoms in the affected individual ("Tularemia," 2006, Internet).

Like many other illnesses in which the transmitter is bacterium-based, tularemia is widespread and has been reported in not only the United States but also in many regions of Europe, Russia, China, and Japan. Globally, there are approximately 500,000 reported cases on an annual basis and in the United States, some three hundred cases are reported yearly with most occurring in the states of Oklahoma, Arkansas and Missouri.

As to exposure, a person may become infected with tularemia when the skin is penetrated or through the mucous membranes by inhaling aerosolized bacteria. Other means of infection include eating infected rabbit meat or being bitten by a tick or fly which has consumed infected meat. However, person-to-person infection, such as with tuberculosis or influenza, has not been reported ("Tularemia," 2006, Internet).

Some of the symptoms of tularemia which generally become known after only two to fours days following infection, includes a "slow-growing ulcer at the site of infection, usually on the hands as a result of handling infected animal meat" (Glanze, 2002, p. 1205) and swollen lymph nodes, such as found in the neck, chest and groin area, known as ulceroglandular infection which accounts for almost 90% of all reported cases of the disease. These slow-growing ulcers often begin as red, itchy spots, much like a mosquito bite, and then gradually enlarge until they ulcerate or break through the skin. Some individuals infected with tularemia have reported symptoms like a sore throat, vomiting, abdominal pain and cramping and diarrhea; some have also reported symptoms similar to pneumonia, but this only occurs when the bacillus is inhaled.

One of the most common symptoms which may be misdiagnosed as another illness is a high fever, ranging between 103 and 104 degrees with the threshold being 105 degrees which often results in death or coma (Glanze, 2002, p. 1205). In addition, other symptoms may include severe headaches, body chills, muscular weakness and pain, profuse sweating, delirium and in extreme cases septicemia in which the bacillus invades the bloodstream, thus causing symptoms similar to typhoid fever ("Tularemia," 2006, Internet).

As to diagnosis of tularemia, infection can only be determined through extensive clinical and laboratory testing via specific blood tests which determine an increase in tularemia antibodies. Sometimes, depending on the severity of the infection, another type of diagnosis involves a biopsy of infected lymphatic tissue which "must be performed with extreme care because of the likelihood for inducing septicemia" in the individual, due to the bacillus being released into the blood during the procedure ("Tularemia, 2006, Internet).

In regards to treatment for tularemia, there are currently a number of prescriptive drugs which are quite effective against the bacillus. One of these is streptomycin sulfate, a rather common antibiotic which is often prescribed for tuberculosis and other related diseases (Glanze, 2002, p. 1121). When a patient is placed on this drug, the therapy usually lasts between one and two weeks, but when relapses occur, two drugs of choice are tetracycline, "a broad spectrum antibiotic similar in nature to streptomycin sulfate" (Glanze, 2002, p. 1159), but because of its toxicity, most physicians prefer other drugs with powerful antibiotic properties.

There are also treatments known as "cocktails" which are generally combinations of streptomycin and some other antibiotic drug. In most cases, once an infected individual was undergone drug therapy for tularemia, they become immune to any future infections in the long-term, yet depending on the severity of the infection, relapses have been reported (Glanze, 2002, p. 1160).

Since the overall source of tularemia is generally through the bite of an insect, such as a tick, a mite or a fly, there are any number of ways to prevent becoming infected with the illness. For example, when a person is outdoors, such as in a heavily-wooded region of the countryside, wearing protective clothing often helps to prevent being bitten by an infected insect.

Also, along with protective clothing, one should use some type of insect repellent, most preferably containing DEET (N, N-diethylmetatoluamide). As pointed out on the official United States Army medical information website, soldiers in the field are almost always required to use DEET as a way of preventing being contaminated with tularemia ("Tularemia, 2006, Internet).

As to decontamination procedures, the Department of Health and Human Services of the U.S. Federal government recommends a number of ways which have been shown to effectively eliminate the tularemia bacillus. Under extreme conditions, such as during some type of widespread tularemia infection as one might find in a war zone or possibly as a result of deliberate infection via a terrorist attack, all medical instruments that have been used to treat victims with cutaneous tularemia "should be autoclaved or decontaminated with 0.5% hypochlorite, a 1:10 dilution of common household bleach." All clothing and bedding should be placed in labeled plastic bags and then disposed of via incineration, steam sterilization or washed in hot water and bleach ("Decontamination," 2009, Internet).