What is tularemia?

Tularemia is also called deer-fly fever, market man disease, or rabbit fever. It is a disease found in animals such as voles, mice, water rats, squirrels, rabbits, hares, and muskrats. It may also be found in insects, birds, hamsters, and domestic cats. The disease is caused by bacteria (germ) called Francisella tularensis. It can infect humans and may cause illness. Tularemia is most common in Arkansas, Missouri, Montana, Oklahoma, and South Dakota.

How do I get tularemia?

The germ can survive for weeks at low temperatures in water, moist soil, hay, straw, and dead animals. The germ may be passed from one animal to another or from an animal to a human. It cannot be passed from one human to another human. Tularemia may get inside the body of its host (animal or human). In the body, the germ divides and grows in the cells and spreads to other organs. You may get the condition through any of the following:

  • Direct contact: You may get the disease by touching the skin, tissues, or fluids of an infected animal. You may also get the disease from any tools that come into contact with an infected animal.

  • Food and water: Infected animals can spread the germs in water through their urine. Eating foods or drinking water that came in contact with the germ may cause your condition.

  • Inhalation: You may become ill by breathing in an infected aerosol (dust or spray). This could happen while mowing, harvesting, or sweeping areas where infected animals lived or died. You may also be infected when you breathe in germ samples used in a lab during tests. Tularemia may be used as biologic weapons against people, animals, food crops, or water supplies. The germs are usually inhaled when used as a weapon of war.

  • Insect bites: Ticks, flies, and mosquitoes may bite an infected animal and carry the germ with them. When the insect bites you, the germ may be passed on to you.

What increases my risk of having tularemia?

  • Age: Very young children and the elderly may have an increased risk for having the condition.

  • Decreased immune system: Your immune system is your body's defense against certain diseases and infections. When your immune system is weak, your risk of getting ill from contact with the germ increases.

  • Hunting: People who hunt wild animals and are in contact with animal blood or fluids are at increased risk. This also includes anyone who eats wild meat that may be infected.

  • Location: Living or visiting places where tularemia is common increases your risk of getting the disease.

  • Work: Working in a lab where the germ is being used for studies increases your risk for the condition. Those working in a pet store, or those who work outside may also be at increased risk.

What are the signs and symptoms of tularemia?

Fever, chills, or headache are usually the first symptoms noticed with a tularemia infection. You may also have weakness, appetite loss, and weight loss. Other signs and symptoms depend on how the germ entered your body. Symptoms may occur two to five days after being infected. You may also have one or more of the following signs and symptoms:

  • Abdominal (stomach) pain, diarrhea (watery, loose bowel movements), or vomiting (throwing up).

  • Bumps or open sores (ulcers) on your skin.

  • Enlarged lymph nodes (small tissues in your body that can trap infections).

  • Eye redness and pain, swelling of your eyelids, or watery eyes.

  • Mouth sores or a sore throat.

  • Muscle and body aches.

  • Trouble breathing, a cough with or without phlegm, and chest pain.

What are the types of tularemia infection?

There are different types of the tularemia infection. All types can occur at the same time, and may have some of the same signs and symptoms. You may have one or more of the following:

  • Glandular: Glands such as your lymph nodes may swell with this type of infection. This type of infection occurs from direct contact with infected animals, insects, or tools.

  • Oculoglandular: This type of infection involves the eye. This may occur by touching your eye with a contaminated finger. It may also occur when infected fluid is splashed into your eye.

  • Oropharyngeal: This type is caused by drinking infected water or eating infected foods. You may have swollen and white patchy tonsils and a sore throat. This often occurs on only one side of your mouth and throat.

  • Pneumonic: This is caused by breathing in the germ and is the most severe type of tularemia infection . The germs are usually in the air as a dust or spray. Tularemia germs that spread through your blood stream into your lungs may also cause this type of infection.

  • Typhoidal: This type of infection may cause severe (very bad) illness. It is usually caused by breathing in the germ, but may have an unclear site of germ entry.

  • Ulceroglandular: This is the most common type of tularemia and results from contact with infected animals, insects, or tools. You will have a sore or sores on your body that are normally seen on your hand first. Lymph nodes found in the same area of your body where you have sores may also be swollen.

What problems may come with tularemia?

Ask your caregiver for more information about the following conditions:

  • Blood problems:

    • Disseminated intravascular coagulation: This is also called DIC. This happens when the blood clotting agents (platelets and certain proteins) in your blood become over-active. This condition may cause serious problems with bleeding or blood flow.

    • Sepsis: This is a severe blood infection that may lead to confusion (trouble thinking clearly), coma or even death.

  • Inflammation: This is when your body tissues or organs become inflamed (swollen). Inflammation may occur in your liver, the lining of your heart chambers, and the tissue covering your brain.

  • Other body problems:

    • Kidney failure: Your kidneys work to remove toxic (harmful) substances in your blood through your urine. When one or both of your kidneys are damaged, harmful substances (things) remain inside your body.

    • Pneumonia: This is a lung infection which may make it hard for you to breathe. Severe pneumonia may cause your lungs to fail, and may lead to death. An abscess (pus pocket) may also form in your lungs with pneumonia.

    • Skin problems: Problems with your skin may include erythema nodosum or erythema multiforme. These conditions may cause small red nodules (lumps) or sores on your legs and arms.

How is tularemia diagnosed?

Your caregiver may ask questions about your complete medical history. He may ask what places you have recently visited. He will do a complete physical exam. You may also need any of the following:

  • Blood tests: You may also need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. Your blood may help your caregiver learn more about your health condition. You may need to have your blood drawn more than once.

  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

  • Cultures: These are done by taking sample tissues from your skin, wound discharge, or phlegm (mucus). Your blood or urine may also be cultured. The tissues are sent to a lab to see if germs grow. Cultures will help your caregiver learn more about your condition. Your caregiver may also test which antibiotic medicine would work the best for treating your infection.

How is tularemia treated?

Antibiotics are given to help you treat your infection. Many antibiotic medicines work well in treating tularemia. The type of antibiotic medicine you will need depends on how bad your condition is. Make sure to follow your caregiver's advice about taking your antibiotics. Do not stop taking your antibiotics until they are gone or your caregiver says it is OK. Your symptoms may go away and come back after a short period of time.

How can I prevent having tularemia?

  • Ask your caregiver about having vaccines against tularemia. The vaccine may only be given to those at risk of being directly exposed to the germ. The vaccination may help, but is not a guarantee of protection from the tularemia germ. Ask your caregiver for more information about the vaccine.

  • Avoid handling or being around sick animals. If avoiding the animal is not possible, use a mask to prevent you from inhaling any germs.

  • Clean anything that comes into contact with the germs thoroughly. Wash your contaminated hands or body areas with soap and water. Tools that have been used on an infected animal should also be cleaned carefully. Use bleach or alcohol to kill the germs and prevent them from spreading.

  • Drink safe water and cook your food well. Only use water from protected wells. Avoid drinking water from sources that you think may not be safe. Always cook your food thoroughly.

  • Remove ticks when you have them. Ticks may come from infected animals and may be seen in humans. Once you see a tick, remove it from your body immediately to decrease your risk of infection. You may also use an insect repellant to prevent infected insects from biting you.

  • Wear protective clothing. Those who are in direct contact with wild rodents or other animals should always wear gloves. Wear clothing that protects you from contact with sick animals. Protective clothing may also be used when cutting bushes or mowing grass. Protective clothing may also prevent infected insects from biting you.

When should I call my caregiver?

Call your caregiver if:

  • You cannot think clearly.

  • You have a fever.

  • You have a rash on your body.

  • You have body weakness.

  • You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You have fainted (passed out).

  • You have severe chest pain.

  • You have shaking chills and a high fever.

  • You suddenly have trouble breathing.

  • Your symptoms do not improve even after taking medicines.

Where can I find more information?

Contact the following:

  • Centers for Disease Control and Prevention (CDC)
    1600 Clifton Road
    Atlanta , GA 30333
    Phone: 1- 800 - 232-4636
    Web Address: http://www.cdc.gov/

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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