eMedicine Specialties > Infectious Diseases > Lower Respiratory Tract Infections

Tularemia: Follow-up

Author: Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Coauthor(s): Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee; Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Contributor Information and Disclosures

Updated: Feb 4, 2009

Follow-up

Further Inpatient Care

  • Care in patients with tularemia primarily involves supportive and general medical care for manifestations that require hospitalization (eg, ARDS, pneumonia, lung abscess, renal insufficiency).

Further Outpatient Care

  • Observe patients for resolution of clinical manifestations and potential toxicities of antibiotics.
  • Relapses of tularemia are common and may be retreated with the same medication because recurrence is usually due to incomplete treatment rather than antimicrobial resistance.

Inpatient & Outpatient Medications

  • Administer antibiotics for 7-14 days to complete a course of treatment (see Medication).

Transfer

  • Transfer patients if complications require therapeutic options (eg, ventilator management, cerebrospinal fluid examination, hemodialysis) unavailable at the initial facility.
  • Consider transfer if evaluation by a subspecialist (eg, infectious diseases specialist, pulmonologist, nephrologist) is needed and those subspecialists are not available at the initial facility.

Deterrence/Prevention

  • Avoid tick bites, if possible, by avoiding tick-infested areas, wearing trousers and long-sleeved shirts, using tick repellants, and by frequently inspecting clothing and bodies for evidence of ticks. Remove ticks promptly by grasping the tick near the mouthparts and pulling upward, taking care to not squeeze the body because tick secretions may be infectious.
  • Avoid exposure to dead or wild mammals, if possible. When exposure is necessary (eg, skinning or eviscerating a rabbit carcass), gloves should be worn, especially if abrasions are on the hands.
  • Frequent and thorough hand washing is also advised.
  • A live attenuated vaccine is available. Although it does not provide complete protection against development of tularemia, it reduces the severity of disease in vaccinated people. Consider it only in people who may have repeated exposure because of vocation (eg, laboratory workers, wild-animal veterinarians, taxidermists).

Complications

  • Pneumonia
  • Lung abscess
  • Respiratory failure, including possible ARDS
  • Rhabdomyolysis
  • Renal failure with possible hemodialysis
  • Hemoptysis
  • Meningitis
  • Endocarditis

Prognosis

  • Untreated tularemia carries a mortality rate of 5-15%.
  • Treated tularemia carries a mortality rate of 1-3%.
  • The mortality rate is 2-3 times higher in patients with typhoidal tularemia than in those with other forms.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider tularemia in the differential diagnoses may lead to death if the patient is not treated properly.
  • Ulceroglandular tularemia is more likely to be diagnosed correctly than the typhoidal form because of the typical presentation of the former. In typhoidal tularemia, epidemiologic information must be carefully obtained from the history to provide clues for the diagnosis.

Special Concerns

  • Because of the risk to laboratory workers, routine culturing of F tularensis is discouraged. If tularemia is suspected in a specimen, notify laboratory workers so that they can take appropriate precautions.
  • F tularensis is a possible agent of bioterrorism. Diagnosis of this disease, especially in the setting of unusual clinical or epidemiological aspects of the presentation, should prompt timely contact with the appropriate public health authorities.7,8
 


More on Tularemia

Overview: Tularemia
Differential Diagnoses & Workup: Tularemia
Treatment & Medication: Tularemia
Follow-up: Tularemia
Multimedia: Tularemia
References
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References

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  8. Gallagher-Smith M, Kim J, Al-Bawardy R, Josko D. Francisella tularensis: possible agent in bioterrorism. Clin Lab Sci. 2004;17(1):35-9. [Medline].

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Further Reading

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Keywords

tularemia, Francisella tularensis, F tularensis, glandular tularemia, ulceroglandular tularemia, oculoglandular tularemia, pulmonary tularemia, pulmonic tularemia, pneumonic tularemia, tularemia pneumonia, oropharyngeal tularemia, typhoidal tularemia, septicemic tularemia, rabbit fever, deer-fly fever, plaguelike disease of rodents, glandular-type of tick fever, wild hare disease, market men's disease, water-rat trapper's disease, tick-borne disease, adult respiratory distress syndrome, ARDS, bioterrorism, biological warfare

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Contributor Information and Disclosures

Author

Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee
Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association
Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Mark R Wallace, MD, FACP, FIDSA, Clinical Professor of Medicine, Florida State University College of Medicine; Infectious Disease Fellowship Director, Orlando Regional Medical Center
Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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