Tularemia is spread by ticks, biting flies, direct contact with infected animals or animal skin, or inhalation of aerosols when doing yard work where infected animals live.
Classified as 7 distinct forms, each of which presents as a different clinical syndrome.
Diagnosis requires a high index of suspicion from the clinical presentation, although it can be confirmed only by serologic testing.
Antibiotic treatment with an aminoglycoside or ciprofloxacin is the mainstay of therapy in all patients, regardless of the clinical syndrome. Doxycycline may also be used.
Prognosis following treatment is excellent.
Tularemia is an infectious disease caused by the gram-negative bacteria Francisella tularensis. It is spread by ticks, biting flies, or direct contact with infected animals or animal skin. It may also be spread by inhalation of aerosols when doing yard work (e.g., mowing the lawn) where infected animals live.
History and exam
Key diagnostic factors
- painful skin ulcer
- unilateral conjunctivitis
Other diagnostic factors
- abdominal pain
- nonproductive cough/dyspnea
- sore throat
- vision impairment/loss
- jaundice, hepatosplenomegaly, diarrhea
- positive Kernig/Brudzinski sign, stiff neck
- tick exposure
- biting fly exposure
- contact with infected animals
- yard work in areas where infected animals live
- spring or summer season
1st investigations to order
- serum electrolyte levels
- serum creatine kinase
- urine dipstick for blood
- erythrocyte sedimentation rate
- blood culture
- specimen culture
- polymerase chain reaction (PCR) of ulcer swab or lymph node aspirate
Investigations to consider
- chest x-ray
- lumbar puncture
- antigen detection in urine
tularemia without meningitis
- Tularemic bacteremia
- Cat scratch disease
- Tickborne diseases of the United States: a reference manual for health care providers
- Practice guidelines for the diagnosis and management of skin and soft tissue infections
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