Tularemia

GENERAL INFORMATION:

What is it?

• Tularemia (too-luh-REE-me-uh) is caused by a bacteria (back-TEER-e-uh) (germ) called Francisella (fran-sis-EL-la) tularensis (too-lar-EN-sis). It is also called rabbit fever or deer-fly fever. Tularemia is a disease of small animals like voles, mice, water rats, squirrels, rabbits, hares, and muskrats. There are several ways tularemia passes from animal to animal, and animal to human. A common way is by insects. Ticks, flies, and mosquitoes may bite an infected animal and carry the germ with them. The germ is transferred when the insect bites another animal or a human being. Humans can also get tularemia by handling animal skins, and eating meat from animals infected with the disease. Other ways humans get tularemia are from infected water, food, and soil. Humans can get tularemia from an aerosol (dust or spray). This can happen by sweeping areas where infected animals lived or died.
  
  
• Tularemia is usually a disease of rural areas. Tularemia has been reported in every U.S. state except Hawaii. Tularemia is most common in Missouri, Arkansas, Oklahoma, Kansas, South Dakota, Montana, and on Martha's Vineyard.
  
  
• Tularemia germs can live for a very long time in below-zero temperatures. Freezing meat from infected animals does not kill tularemia germs. The germs are easily killed by heat and disinfectants.

Is tularemia contagious? Tularemia is not contagious. It cannot be passed from one person to another in the same way as colds or flu. You get tularemia by eating, drinking, touching, breathing dust from, or being bitten by, an animal or insect carrying the germ.

What are the signs and symptoms of tularemia? There are 6 types of tularemia. Symptoms depend on how and where the germ enters your body. It is possible to get pneumonia with all types of tularemia.

• Ulceroglandular (ull-sir-oh-GLAN-dew-lar): This is by far the most common type of tularemia. It is usually caused by a tick bite. There is usually a skin sore where the person was bitten. The sore is red, hard, does not heal, and looks "punched out". Then the sore becomes an ulcer (ULL-sir). The skin is gone over the top of the sore and it becomes red and open-looking. The ulcer develops a black base. Glands in the area of the ulcer swell. Children usually have swollen glands in the head and neck because that is where they are usually bitten. Adults usually have swollen glands in the groin area (the place where the top of the leg meets the abdomen). Adults are more often bitten on the legs by ticks. Other symptoms of this type of tularemia are fever, chills, headache, and tiredness.
  
  
• Glandular (GLAND-dew-lar): This is the second most common type of tularemia. In glandular tularemia the symptoms are fever and sore, swollen glands. There is no obvious ulcer.
  
  
• Typhoidal (tie-FOY-dul): This type is usually caused by breathing in the tularemia germ, but may also be caused by being bitten by an insect. You may also eat or drink something (meat, soil, water) with the tularemia germ in it. Symptoms of typhoidal tularemia include fever, extreme tiredness, and weight loss. Your glands will not be swollen with this type of tularemia. Almost everyone with this type of tularemia also has pneumonia.
  
  
• Oculoglandular (ock-u-low-GLAN-dew-lar): This type of tularemia is caused by the germ getting into the eye area. It can happen by touching your eyes with hands that have the tularemia germ on them. It can also happen if fluid is splattered into the eye area or if the germ is sprayed into the eye area. With this kind of tularemia you will have an eye infection in one eye. Pus will come from the eye area. The glands in your neck will be swollen. The area around your eye will be swollen, too. The inside eyelid area may have an ulcer.
  
  
• Oropharyngeal (or-o-fair-n-GEE-ul): This type of tularemia is caused by the germ getting into your mouth or throat. Your throat will be sore and the glands in your neck will be swollen. Your throat will make a lot of phlegm (flem).
  
  
• Pneumonic (new-MON-ick): This type of tularemia can be caused in two ways. You can get it by inhaling the tularemia germ, usually as a dust or spray. You can also get it with another type of tularemia.

How is tularemia treated? Several antibiotics (an-ti- bi-AH-tiks) work well on tularemia. Make sure to follow your caregiver's advice about taking antibiotics. Tularemia can be hard to get rid of if your antibiotics are not strong enough, or you do not take them long enough. Tularemia symptoms may go away while you are taking antibiotics, making you believe that you are disease-free. The symptoms may then come back a week or so later.

Is there a vaccine for tularemia? There is a vaccine for tularemia, although it is not always available. For the vaccine to work, you must have it before you are exposed to the germ. Since 1990, less than 200 cases have been reported in the U.S. on average each year. Because tularemia is so rare, the vaccine is only given to people who will be directly exposed to the germ. The vaccine should protect you from natural tularemia. Once you have had tularemia, you will not get it again.

What should I do if I am exposed to tularemia? Notify your caregiver right away if you are exposed to tularemia. If you are not having symptoms, your caregiver may want you to take antibiotics to keep you from getting sick. If you are already having symptoms, your caregiver may want you to be in the hospital.

What is the risk of an outbreak?

• Outbreaks in humans usually follow animal outbreaks. You are more likely to get tularemia if you hunt, trap, butcher animals, or live on a farm.
  
  
• In the 1950's and 60's the United States made weapons that could spray tularemia on large numbers of people. All the U.S. weapons using tularemia were destroyed by 1973. It is possible that other countries have developed the same kind of weapons. Those weapons may still exist.
  
  
• In case of a biological attack, it would take between 1 and 14 days to have symptoms of tularemia. The usual time is 3-5 days. An attack would probably come in spray form and cause typhoidal or pneumonic tularemia.

Where can I get more information about tularemia?

• Centers for Disease Control and Prevention
  1600 Clifton Road
  Atlanta, GA 30333
  Phone: 1-404-6393311
  Phone: 1-800-3113435
  Web Address: http://www.cdc.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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