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Tularemia Fact Sheet for Patients

What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals
(especially rodents, rabbits, and hares).

People can get tularemia many different ways, such as through the bite of an infected insect or other arthropod (usually a tick or deerfly), handling infected animal carcasses, eating or drinking contaminated food or water, or breathing in
F. tularensis
.

Signs and Symptoms:

Symptoms of tularemia could include sudden fever, chills, headaches, muscle aches, joint pain, dry cough, progressive weakness, and pneumonia. Persons with pneumonia can develop chest pain and bloody spit and can have trouble breathing or can sometimes stop breathing. Other symptoms of tularemia depend on how a person was exposed to the tularemia bacteria. These symptoms can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can take as long as 14 days.

Tularemia is not known to be spread from person to person, so people who have tularemia do not need to be isolated.

A vaccine for tularemia is under review by the Food and Drug Administration and is not currently available in the United States.

How do people become infected with the tularemia bacteria?
Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies) that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking contaminated food or water, or by inhaling infected aerosols.

Does tularemia occur naturally in the United States?
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.

Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.

Can tularemia be effectively treated with antibiotics?
Yes. After potential exposure or diagnosis, early treatment is recommended with an antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, which are taken orally, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.

Tularemia FAQs for Healthcare Workers and Providers

What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals (especially rodents, rabbits, and hares).

Signs and Symptoms:

Depending on the route of exposure, the tularemia bacteria may cause skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, oral ulcers, or pneumonia. If the bacteria were inhaled, symptoms would include the abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. Persons with pneumonia can develop chest pain, difficulty breathing, bloody sputum, and respiratory failure. 40% or more of persons with the lung and systemic forms of the disease may die if they are not treated with appropriate antibiotics.

How do people become infected with the tularemia bacteria?
Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies) that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking contaminated food or water, or by inhaling infected aerosols.

Does tularemia occur naturally in the United States?
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.

Why are we concerned about tularemia as a bioweapon?
Francisella tularensis is highly infectious: a small number of bacteria (10-50 organisms) can cause disease. If tularensis were used as a bioweapon, the bacteria would likely be made airborne for exposure by inhalation. Persons who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they were not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.

Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.

How quickly would someone become sick if they were exposed to the tularemia bacteria?
The incubation period for tularemia is typically 3 to 5 days, with a range of 1 to 14 days.

What should someone do if they suspect they or others have been exposed to the tularemia bacteria?

Seek prompt medical attention. If a person has been exposed to Francisella tularensis, treatment with tetracycline antibiotics for 14 days after exposure may be recommended.

Local and state health departments should be immediately notified so an investigation and control activities can begin quickly. If the exposure is thought to be due to criminal activity (bioterrorism), local and state health departments will notify CDC, the FBI, and other appropriate authorities.

How is tularemia diagnosed?
When tularemia is clinically suspected, the healthcare worker will collect specimens, such as blood or sputum, from the patient for testing in a diagnostic or reference laboratory. Laboratory test results for tularemia may be presumptive or confirmatory.  Presumptive (preliminary) identification may take less than 2 hours, but confirmatory testing will take longer, usually 24 to 48 hours.

Can tularemia be effectively treated with antibiotics?
Yes. After potential exposure or diagnosis, early treatment is recommended with an antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, which are taken orally, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.

How long can Francisella tularensis exist in the environment?
Francisella tularensis can remain alive for weeks in water and soil.

Is there a vaccine available for tularemia?
In the past, a vaccine for tularemia has been used to protect laboratory workers, but it is currently under review by the Food and Drug Administration.

 

 

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