Tularemia: Symptoms, Causes, Prevention, Treatment

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Main Digest

Tularemia is a form of rare infectious disease that can attack a person's eyes, skin, lungs, lymph nodes and possibly even other internal organs. Often times referred to as, "rabbit fever," or, "deer fly fever," tularemia is caused by the bacterium, "Francisella tularensis." The disease largely affects mammals; particularly rabbits, rodents and hares - although it may also infect reptiles, birds and fish.

Tularemia spreads to people through a number of ways, to include direct exposure to an infected animal and insect bite. The disease is highly contagious and has the potential to be fatal. Tularemia can usually be treated effectively with specific antibiotics if a person is diagnosed early enough.

Symptoms of Tularemia

The majority of people who have been exposed to tularemia and become ill usually experience symptoms within 2-10 days. A number of types of tularemia exist and which type a person gets is dependent upon how and where the bacteria enter their body. In most instances, the bacteria enter through a person's mucous membranes or skin, although they may also be eaten or inhaled. Each form of tularemia presents its own set of symptoms.

• Glandular Tularemia: People who experience glandular tularemia have the same signs and symptoms of ulceroglandular tularemia, except they do not experience skin ulcers.
• Oculoglandular Tularemia: Oculoglandular tularemia affects a person's eyes and may cause eye redness, eye pain, an ulcer on the inside of the person's eyelid, eye swelling and discharge.
• Ulceroglandular Tularemia: Ulceroglandular tularemia is definitely the most common form of the disease. Its signs and symptoms include fever, chills, headache, exhaustion, swollen and painful lymph glands, and a skin ulcer that forms at the site of the person's infection.
• Oropharyngeal Tularemia: Oropharyngeal tularemia is usually caused by consuming poorly prepared wild animal meat, or drinking contaminated water; it usually affects a person's digestive tract. The signs and symptoms include fever, vomiting, diarrhea, mouth ulcers and a sore throat.
• Typhoidal Tularemia: Typhoidal tularemia is a rare and serious form of the disease. Typhoidal tularemia presents some dangerous signs and symptoms such as a high fever, pneumonia, extreme exhaustion, enlargement of a person's liver, vomiting, diarrhea, and enlargement of a person's spleen.
• Pneumonic Tularemia: Pneumonic tularemia is most commonly experienced by seniors and people with typhoidal tularemia. Pneumonic tularemia causes signs and symptoms typically associated with pneumonia such as chest pain, cough and trouble with breathing. Other forms of tularemia have the potential to spread to a person's lungs.

If you think you might have been exposed to tularemia, particularly if you have handled a wild animal or been bitten by a tick in an area where tularemia is found and are now experiencing a fever, swollen glands or skin ulcers, it is important for you to visit a doctor as soon as you can. If you test positive for a form of tularemia, you will need to begin antibiotic treatment promptly.

Causes of Tularemia

Tularemia does not occur naturally in people and is not known to pass from person to person. The disease does; however, occur globally - particularly in rural areas, because many birds, mammals, fish and insects are infected with F. tularensis. The organism has the ability to live for weeks in water, soil and dead animals.

Unlike some infectious diseases that spread from animals to people through one single route, tularemia has a number of modes of transmission. How a person gets the disease usually determines the type and severity of their symptoms. Generally, a person can get tularemia through some different ways:

• Insect Bites: While many insects carry tularemia, deer flies and ticks are most likely to transmit the disease to people. Tick bites cause a large number of instances of ulceroglandular tularemia.
• Airborne Bacteria: Bacteria in soil may become airborne during construction, gardening, or other activities that disturb soil. Inhaling the bacteria may lead to pneumonic tularemia. Laboratory workers who work with tularemia are also at risk of airborne infection.
• Exposure to Sick or Dead Animals: Ulceroglandular tularemia may also result from handling or being bitten by an infected animal - most often a rabbit or hare. Bacteria enter a person's skin through small cuts and abrasions, or a bit, and an ulcer forms at the site of the wound. The ocular form of tularemia can occur when a person rubs their eyes after touching an animal that is infected.
• Food or Water Contamination: While uncommon, it is possible to get tularemia from eating undercooked meat from an infected animal, or drinking water that is contaminated. The signs include diarrhea, vomiting and additional digestive issues. Heat kills F. tularensis, so it is important to cook meat to the proper temperature; at least 160 F/71.1 C for pork, ground meat and game meat and 145 F/62.8C for farm-raised roasts and steaks.

Risk Factors for Tularemia

Anyone from any age group may develop tularemia. Pursuing certain activities, occupations, or living in certain areas increase a person's risk of the disease. For example; In America, people who live in or visit areas of Missouri, Oklahoma and Arkansas might be at increased risk due to the concentration of ticks in those areas. If a person has certain job or pursues certain hobbies, they may also be at increased risk of tularemia. Jobs and hobbies such as the following may increase a person's risk:

• Hunting/Trapping: Due to the fact that hunters handle wild animals, are exposed to animal blood and might consume their flesh they are at an increased risk of tularemia.
• Gardening/Landscaping: Gardeners and Landscapers might also be at risk of tularemia and are more likely to develop pneumonic tularemia. Pneumonic tularemia is one of the least common and most deadly forms of tularemia. It is possible that gardeners inhale bacteria while working with soil, or when using weed trimmers or lawn mowers.
• Veterinary Medicine or Wildlife Management: People who work with wildlife or other animals are at an increased risk of tularemia.

Complications

Tularemia presents a number of complications. It may be fatal if left untreated. The complications of tularemia include the following:

• Lung Inflammation: Pneumonia may lead to respiratory failure, a condition in which a person's lungs do not take in enough oxygen, release enough carbon dioxide, or both.
• Bone Infection: Tularemia bacteria at times spread to a person's bones leading to pain and a decrease in the person's range of motion in their joints. At times the bacteria lead to skin tenderness, redness or open sores in areas that are affected.
• Heart Irritation: The irritation involves swelling of a person's, 'pericardium,' which is a thin membrane surrounding the person's heart. Mild pericarditis often times improves without treatment, yet more serious instances might require antibiotic therapy.
• Meningitis: Meningitis is a serious and at times life-threatening infection of the fluids and membranes surrounding a person's spinal cord and brain. The signs and symptoms of bacterial meningitis include a high fever, stiff neck, severe headache and light sensitivity. If it is not treated quickly, bacterial meningitis may cause brain damage or even death.

Testing For and Diagnosing Tularemia

Due to the fact that tularemia is rare and because it shares symptoms with other forms of diseases, it might be hard to diagnose. Doctors may check for F. tularensis in a person's sputum or blood sample that is cultured and encourage the growth of the bacteria. Yet the preferred method of diagnosing tularemia is to identify antibodies to the bacteria in a sample of a person's blood. A doctor is also likely to order a chest X-ray in order to look for signs of pneumonia.

Treatment

Tularemia can be effectively treated with antibiotics such as gentamicin or streptomycin, administered through injection directly into a person's vein or muscle. Depending upon the form of tularemia a person experiences, a doctor might prescribe oral antibiotics such as doxycycline instead. A person with tularemia will also receive therapy for any complications such as pneumonia or meningitis. Generally, a person should be immune to tularemia after they have recovered, although some people might experience a recurrence of the disease or reinfection.

Prevention

Attempts to develop a vaccine for tularemia have so far been unsuccessful. If you live in an area where tularemia is present, or work in a high-risk job, the following measures may help to reduce your chances of infection:

• Take Care when Gardening: Home gardeners and professional landscapers should consider wearing a face mask while excavating soil, mowing lawns, or clearing brush or weeds.
• Handle Animals with Care: If you hunt or handle wild rabbits or hares, wear protective goggles and gloves. Wash your hands thoroughly with hot water and soap after touching animals. Cook all wild meats completely and avoid skinning or dressing any animal that seemed to be sick.
• Protect Your Pets: Pets and livestock can contract tularemia if they eat part of a diseased rabbit, or if they are bitten by an infected tick. Avoid letting them outside unsupervised. Provide them with flea and tick protection and do not allow them to come into close contact with wild or dead animals.
• Protect Yourself from Insects: The majority of people who get tularemia do so through tick bites. If you spend time in tick-infested areas, wear long-sleeved shirts and long pants. Tuck your pants into your socks and use a broad-brimmed hat to help protect your neck and face. Check your skin and clothing often for ticks and tick bites.
• Use Insect Repellent: Follow the manufacturer's directions carefully. Products containing DEET are still considered to be the most effective against ticks, although oil of eucalyptus, lemon, or natural insecticides might offer you some level of protection. Use the lowest concentration of repellent for the circumstances and apply it moderately. Wash the repellent off at the end of the day. Do not use repellents containing DEET on infants or children younger than 2 months.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.

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