Pediatric Tularemia Follow-up

  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 23, 2010
 

Further Inpatient Care

  • Inpatient care in patients with tularemia should be guided by consultation with an infectious disease specialist.
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Further Outpatient Care

  • Close outpatient follow-up with a primary care physician is essential for any case of suspected tularemia.
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Inpatient & Outpatient Medications

  • See Medication for treatment of acute tularemia.
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Transfer

  • Transfer of care depends on the level of clinical support and laboratory capabilities at the treatment facility.
  • Any considerations for transfer should be in consultation with an infectious diseases specialist.
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Deterrence/Prevention

  • Limit exposure to ticks and deerflies in the United States, and mosquitos in Europe.
  • Use insecticides and protective clothing when exposed to insect vectors.
  • Avoid contact with wild animal blood and flesh, including rabbits, particularly when hunting or processing carcasses. Take special care to avoid touching the face or eyes while handling animals.
  • A live attenuated vaccine is available as an investigational agent from the US Army Medical Research Institute of Infectious Diseases (USAMRIID) in Fort Detrick, Maryland. The vaccine is derived from avirulent F tularensis biovar holarctica (type B) and produces partial protection.[41]
  • Postexposure prophylaxis is recommended within 24 hours of airborne exposure using tetracycline, ciprofloxacin or doxycycline for 2 weeks. It is unlikely that aerosolized exposure to F tularensis is identified within 24 hours. Therefore, standard treatment is recommended within 14 days of exposure.
  • Organisms are relatively easily to render harmless by mild heat (55°C for 10 min) and standard disinfectants. Decontamination of inanimate objects may be performed using 10% bleach, which may be followed by a 70% alcohol solution to further decontaminate and to decrease the corrosive effects of the bleach.
  • A jackrabbit dieoff near a metropolitan airport in Texas due to epizootic tularemia illustrated the importance of animal surveillance, EMS and Public Health pre-event planning, and training exercises in outbreak prevention.[42]
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Complications

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Prognosis

  • Untreated typhoidal tularemia can have a mortality rate as high as 30%, but the overall mortality rate for tularemia is less than 10%.
  • Treated tularemia has a mortality rate of less than 1%. Life-long immunity usually results after infection.
  • Factors affecting the prognosis include the following:
    • Typhoidal (septicemic) presentation
    • Elevated creatine kinase
    • Renal failure
    • Delayed diagnosis
    • Comorbid conditions
  • Lifelong immunity usually results after infection.
  • Jarisch-Herxheimer-like reactions have been described after initiation of treatment for tularemia.
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Patient Education

  • Direct patient education at limiting tick and deerfly exposure and instruct the patient regarding the importance of hunter education for contact precautions and good hygiene while handling rabbits and other wild animals.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.
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Contributor Information and Disclosures
Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Specialty Editor Board

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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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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