Tularemia in Emergency Medicine Treatment & Management

  • Author: Kelly Maurelus, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 19, 2011
 

Emergency Department Care

  • Consider tularemia in patients with fever and regional lymphadenopathy, particularly when an ulcer or conjunctivitis is present.
  • The typhoidal form presents as a nonspecific febrile illness with little to suggest tularemia in the absence of a careful epidemiologic history taking. In patients with this form of the disease, other potentially life-threatening infections should be considered and excluded or treated as appropriate.
  • Supportive care with fluids and antipyretics may be indicated.
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Consultations

  • Consultation with an infectious diseases specialist often is indicated.
  • Discussion with public health authorities is important if a cluster of cases is seen, given that this could represent a biological attack.
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Contributor Information and Disclosures
Author

Kelly Maurelus, MD  Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate

Kelly Maurelus, MD, is a member of the following medical societies: American Medical Student Association/Foundation and Student National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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 

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

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. Matero P, Hemmila H, Tomaso H, et al. Rapid field detection assays for Bacillus anthracis, Brucella spp., Francisella tularensis and Yersinia pestis. Clin Microbiol Infect. Jan 2011;17(1):34-43. [Medline].

  4. 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].

  5. Alsan MM, Lin HW. Tularemia presenting as a cervical abscess. Otolaryngol Head Neck Surg. Aug 2010;143(2):311-2.e1. [Medline].

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

  7. 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].

  8. 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].

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

  10. Foley JE, Nieto NC. Tularemia. Vet Microbiol. Jan 27 2010;140(3-4):332-8. [Medline].

  11. 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].

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

  13. Langley R, Campbell R. Tularemia in North Carolina, 1965-1990. N C Med J. Jul 1995;56(7):314-7. [Medline].

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

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

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

  17. 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].

  18. 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].

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

 
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Ulceroglandular tularemia on the face. 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.
 
 
 
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