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Symptoms, diagnosis and causes of tularemia

Symptoms, diagnosis and causes of tularemia

Symptoms, diagnosis and causes of tularemia

Symptoms, diagnosis and causes of tularemia

Tests and investigations

Tularaemia is primarily a zoonotic disease of the northern hemisphere. It is a serious infectious disease caused by the bacterium Francisella tularensis.

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Incidence, age and sex

Incidence rates are dropping and the rate in Europe is less than 1 per 1,000,000,

Signs and symptoms

The most common “ulceroglandular variety of the disease (70-80%) is characterized by skin ulceration with regional lymphadenopathy. There is a purely ‘glandular’ form of the disease. Inhalation of the infected aerosols may result in pulmonary tularaemia, presenting as pneumonia. Rarely, the portal of entry of infection may be the conjunctiva, leading to a nodular, ulcerated conujunctivitis with regional lymphnode enlargement (an ‘oculoglandular’ form).

Demonstration of a single high titre (>- 1:160) or a fourfold rise in 2 – 3 weeks in the tularaemia tube agglutination test confirms the diagnosis. Bacterial yield from the lesions is extremely poor. PCR and real-time PCR have been developed for reliable and rapid diagnosis.

Causes and prevention

It is caused by a highly-infectious Gram-negative bacillus -Francisella tularensis. Wild rabbits, domestic dogs or cats are the reservoirs and ticks are the vectors. Infection is introduced either through the bite of ticks, or from animals through skin abrasions. An attenuated, live vaccine is available, but its use is restricted to high risk groups. The best way to prevent tularemia infection is to wear rubber gloves when handling or skinning rabbits, avoid ingesting uncooked wild game and untreated water sources, wear long-sleeved clothes and use an insect repellent to prevent tick bites.

Complications

The complications of tularemia include bone infection (osteomyelitis), infection of the sac around the heart (pericarditis),meningitis and pneumonia.

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