Tularemia Follow-up

  • Author: Kerry O Cleveland, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 12, 2012
 

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).
Next

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.
Previous
Next

Inpatient & Outpatient Medications

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

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.
Previous
Next

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).
Previous
Next

Complications

  • Pneumonia
  • Respiratory failure, including possible ARDS
  • Rhabdomyolysis
  • Renal failure with possible hemodialysis
  • Hemoptysis
  • Meningitis
  • Endocarditis
Previous
Next

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.
Previous
Next

Patient Education

  • See Deterrence/Prevention.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.
Previous
 
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, 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 School of Medicine; 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.

Specialty Editor Board

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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.

References

  1. Trevisanato SI. The 'Hittite plague', an epidemic of tularemia and the first record of biological warfare. Med Hypotheses. May 11 2007;[Medline].

  2. Francis E. A summary of present knowledge of Tularaemia. Medicine. 1928;7:411-32.

  3. Hauri AM, Hofstetter I, Seibold E, Kaysser P, Eckert J, Neubauer H, et al. Investigating an airborne tularemia outbreak, Germany. Emerg Infect Dis. Feb 2010;16(2):238-43. [Medline]. [Full Text].

  4. Rydén P, Björk R, Schäfer ML, Lundström JO, Petersén B, Lindblom A, et al. Outbreaks of tularemia in a boreal forest region depends on mosquito prevalence. J Infect Dis. Jan 2012;205(2):297-304. [Medline]. [Full Text].

  5. Hansen CM, Vogler AJ, Keim P, Wagner DM, Hueffer K. Tularemia in alaska, 1938 - 2010. Acta Vet Scand. Nov 18 2011;53:61. [Medline]. [Full Text].

  6. Thomas LD, Schaffner W. Tularemia pneumonia. Infect Dis Clin North Am. Mar 2010;24(1):43-55. [Medline].

  7. van de Beek D, Steckelberg JM, Marshall WF, Kijpittayarit S, Wijdicks EF. Tularemia with brain abscesses. Neurology. Feb 13 2007;68(7):531. [Medline].

  8. Mitchell LA, Bradsher RW Jr, Paden TC, Malak SF, Warmack TS, Nazarian SM. Tularemia induced bilateral optic neuritis. J Ark Med Soc. Mar 2006;102(9):246-9. [Medline].

  9. Gelfand MS, Slade W, Abolnik IZ. Tularemia serology: Differentiating true-positive and false-positive titers. Inf Dis Clin Pract. 1992;1:105-8.

  10. Tärnvik A, Chu MC. New approaches to diagnosis and therapy of tularemia. Ann N Y Acad Sci. Apr 27 2007;[Medline].

  11. Cronquist SD. Tularemia: the disease and the weapon. Dermatol Clin. Jul 2004;22(3):313-20, vi-vii. [Medline].

  12. 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].

  13. [Medline].

  14. Choi E. Tularemia and Q fever. Med Clin North Am. Mar 2002;86(2):393-416. [Medline].

  15. Cunha BA. Bioterrorism in the Emergency Room: Anthrax, Tularemia, Plague, Ebola, and Smallpox. Clin Microbiol Infect. 2002;8:489-503.

  16. Cunha BA. Tularemia. In: Tickborne Infectious Diseases: Diagnosis and Management. Marcel Dekker; 2000:251-68.

  17. Dienst FT. Tularemia: a perusal of three hundred thirty-nine cases. J La State Med Soc. Apr 1963;115:114-27. [Medline].

  18. Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev. Oct 2002;15(4):631-46. [Medline].

  19. Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30-year experience with 88 cases. Medicine (Baltimore). Jul 1985;64(4):251-69. [Medline].

  20. Farlow J, Wagner DM, Dukerich M, Stanley M, Chu M, Kubota K. Francisella tularensis in the United States. Emerg Infect Dis. Dec 2005;11(12):1835-41. [Medline].

  21. Gill MV, Cunha BA. Tularemia Pneumonia. Sem Respir Infect. 1997;13:61-67.

  22. Guffey MB, Dalzell A, Kelly DR, Cassady KA. Ulceroglandular tularemia in a nonendemic area. South Med J. Mar 2007;100(3):304-8. [Medline].

  23. Kandemir B, Erayman I, Bitirgen M, Aribas ET, Guler S. Tularemia presenting with tonsillopharyngitis and cervical lymphadenitis: report of two cases. Scand J Infect Dis. 2007;39(6-7):620-2. [Medline].

  24. Leblebicioglu H, Esen S, Turan D, Tanyeri Y, Karadenizli A, Ziyagil F, et al. Outbreak of tularemia: a case-control study and environmental investigation in Turkey. Int J Infect Dis. May 2008;12(3):265-9. [Medline].

  25. Markowitz LE, Hynes NA, de la Cruz P, et al. Tick-borne tularemia. An outbreak of lymphadenopathy in children. JAMA. Nov 22-29 1985;254(20):2922-5. [Medline].

  26. Matyas BT, Nieder HS, Telford SR 3rd. Pneumonic tularemia on Martha's Vineyard: clinical, epidemiologic, and ecological characteristics. Ann N Y Acad Sci. Jun 2007;1105:351-77. [Medline].

  27. Nigrovic LE, Wingerter SL. Tularemia. Infect Dis Clin North Am. Sep 2008;22(3):489-504. [Medline].

  28. Penn RL, Kinasewitz GT. Factors associated with a poor outcome in tularemia. Arch Intern Med. Feb 1987;147(2):265-8. [Medline].

  29. Sinclair JR, Newton A, Hinshaw K, Fraser G, Ross P, Chernak E, et al. Tularemia in a park, Philadelphia, Pennsylvania. Emerg Infect Dis. Sep 2008;14(9):1482-3. [Medline].

  30. Sjöstedt A. Tularemia: history, epidemiology, pathogen physiology, and clinical manifestations. Ann N Y Acad Sci. Jun 2007;1105:1-29. [Medline].

 
Previous
Next
 
Eschar on thumb and under thumbnail at the site of a rabbit bite in a patient with tularemia.
Axillary bubo in a patient with tularemia.
Ulceroglandular type of tularemia on the hand. Courtesy of Dr Hon Pak.
Ulceroglandular tularemia on an extremity. Courtesy of Dr Hon Pak.
Ulceroglandular type of tularemia on the hand. Courtesy of Dr Hon Pak.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.