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Tick-Borne Diseases, Tularemia: Follow-up

Author: Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Vice Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Contributor Information and Disclosures

Updated: Dec 9, 2008

Follow-up

Further Outpatient Care

  • Any patient being treated as an outpatient for tularemia should undergo close follow-up, preferably with his or her primary care physician.

Deterrence/Prevention

  • When hunting rabbits or skinning or preparing rabbit carcasses, great care must be taken to avoid touching the rabbit blood and flesh. Touching one's eyes should be avoided while performing these activities. Hands should be washed thoroughly afterwards.
  • For other suggestions for avoiding tick bites, see Tick-borne Diseases, Introduction.

Complications

Complications of tularemia may include the following:

  • Pneumonia
  • Hemoptysis
  • Lung abscess
  • Respiratory failure
  • Rhabdomyolysis
  • Renal failure requiring dialysis

Prognosis

  • Roughly 5-15% of untreated patients die of the disease.
  • Factors associated with increased mortality include typhoidal presentation, elevated creatine kinase levels, renal failure, late diagnosis, or other serious comorbidities.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider this treatable and potentially fatal infection is a major pitfall.
    • When the ulceroglandular form is present, the physician is more likely to consider tularemia.
    • The typhoidal form, which is more deadly, is usually accompanied by few clues and is therefore difficult to diagnose unless the physician routinely searches for the epidemiologic clues.

Special Concerns

  • Because F tularensis is so infectious, it has been considered as a biological weapon. In fact, some have speculated that the tularemia outbreak prior to the Battle of Stalingrad in 1942, was the result of weaponized tularemia developed by the Soviets. While not person-to-person transmissible, tularemia organisms delivered by aerosol could infect a large number of individuals. Being alert to an outbreak of pneumonia that is consistent with tularemia or an outbreak in which tularemia turns out to be the cause should suggest a possible biological attack. This is especially true if such a cluster of cases were to occur in urban or suburban environments, where the natural exposure to the organism is much less common.
  • Similarly, if a laboratory technician were to present with tularemia or a syndrome suggesting it, steps should be taken to ensure that no safety breaches occur in the laboratory in order to prevent subsequent cases.
 


More on Tick-Borne Diseases, Tularemia

Overview: Tick-Borne Diseases, Tularemia
Differential Diagnoses & Workup: Tick-Borne Diseases, Tularemia
Treatment & Medication: Tick-Borne Diseases, Tularemia
Follow-up: Tick-Borne Diseases, Tularemia
Multimedia: Tick-Borne Diseases, Tularemia
References
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References

  1. CDC. Tularemia associated with a hamster bite--Colorado, 2004. MMWR Morb Mortal Wkly Rep. Jan 7 2005;53(51):1202-3. [Medline].

  2. 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].

  3. Perez-Castrillon JL, Bachiller-Luque P, Martin-Luquero M, et al. Tularemia epidemic in northwestern Spain: clinical description and therapeutic response. Clin Infect Dis. Aug 15 2001;33(4):573-6. [Medline].

  4. Craven RB, Barnes AM. Plague and tularemia. Infect Dis Clin North Am. Mar 1991;5(1):165-75. [Medline].

  5. Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a biological weapon: medical and public health management. JAMA. Jun 6 2001;285(21):2763-73. [Medline].

  6. Eliasson H, Broman T, Forsman M. Tularemia: current epidemiology and disease management. Infect Dis Clin North Am. Jun 2006;20(2):289-311, ix. [Medline].

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  8. Ikaheimo I, Syrjala H, Karhukorpi J, et al. In vitro antibiotic susceptibility of Francisella tularensis isolated from humans and animals. J Antimicrob Chemother. Aug 2000;46(2):287-90. [Medline].

  9. Jacoby I. Francisella tularensis (tularemia) attack. In: Ciottone G, ed. Disaster Medicine. Philadelphia, Pa: Mosby; 2006.

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  11. Limaye AP, Hooper CJ. Treatment of tularemia with fluoroquinolones: two cases and review. Clin Infect Dis. Oct 1999;29(4):922-4. [Medline].

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  14. Schmid GP, Kornblatt AN, Connors CA, et al. Clinically mild tularemia associated with tick-borne Francisella tularensis. J Infect Dis. Jul 1983;148(1):63-7. [Medline].

  15. Staples JE, Kubota KA, Chalcraft LG. Epidemiologic and molecular analysis of human tularemia, United States, 1964-2004. Emerg Infect Dis. Jul 2006;12(7):1113-8. [Medline].

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Further Reading

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Keywords

tick-borne disease, tularemia, Francisella tularensis, F tularensis, ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic, typhoidal, rabbit fever, deer-fly fever, vector-borne disease, tularensis strain

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Contributor Information and Disclosures

Author

Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Vice Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Jonathan A Edlow, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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