TularaemiaA21.90

Author:Prof. Dr. med. Peter Altmeyer

Co-Autor:Dr. med. Ouadie El Makhtoum

All authors of this article

Last updated on: 30.03.2021

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Synonym(s)

Allergized tularaemia; cutaneous-glandular tularaemas; Deer fly fever; Deer Fly Fever; Francisella tularensis infection; Hare Plague; Lemming Disease; Lemming Fever; muco-glandular tularaemia; oculo-glandular tularaemia; Ohara's disease; rabbit fever; Rabbit fever; Rodent disease; typhoid tularaemia; ulcero-glandular tularaemia

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HistoryThis section has been translated automatically.

Chapin and Mc Coy 1912; Wherry and Lamb 1914

DefinitionThis section has been translated automatically.

Rare, plague-like rodent disease in Europe with possible transmission to humans (zoonosis) and typical primary complex. Duty to report! S.a. tularemia.

PathogenThis section has been translated automatically.

Francisella tularensis; gram-negative, coccoid, difficult to cultivate rods.F. tularensis is considered a highly contagious pathogen that can be transmitted by skin or mucous membrane contact with infected animals or their remains (e.g. hunters), consumption of contaminated, insufficiently heated meat (rabbits). Transmission by mosquitoes (Aedes spp., Chrysops spp.) or ticks (Dermacentor spp.) is also described. Transmission is also possible by contact via contaminated dust (faeces of infected animals) or contaminated water. Hares, beavers and ticks (Dermacentor spp.) are the main reservoirs of the pathogen.

Occurrence/EpidemiologyThis section has been translated automatically.

Rarely, in Germany 20 to 50 cases/year are registered. Occurrence has been described especially in the rural population in Scandinavia, Russia, Japan, China, USA, Canada.

EtiopathogenesisThis section has been translated automatically.

Penetration of the pathogen into the human skin through small skin injuries, as well as through tick and fly bites. Infections by eating raw infected meat or drinking water as well as laboratory infections are possible.

ManifestationThis section has been translated automatically.

Predominantly 5-10 LJ or occurring in older adults after the 60th LJ.

LocalizationThis section has been translated automatically.

Especially the hands are affected.

Clinical featuresThis section has been translated automatically.

Incubation period: 2-14 days. General symptoms with headache and muscle pain may occur. A distinction is made between:

  • Cutaneous-glandular tularemia (ulcero-glandular form): primary effect at the site of entry, small nodular, livid infiltrate, ulcerating pustule. Painful, purulent melting, regional lymph node swelling, fistula formation. Development of a typhoid-like picture and atypical pneumonia are possible (5th day of illness). Roseolae and splenomegaly may occur.
  • Muco-glandular tularemia: primary effect on the oral mucosa in the form of aphthae. Involvement of regional lymph nodes corresponding to the cutaneous-glandular form.
  • Oculo-glandular tularemia: conjunctivitis, eyelid edema, involvement of regional lymph nodes. Usually spontaneous healing. Pulmonary (lung infiltrates) and abdominal forms are also observed with appropriate ports of entry. Immunity against systemic tularemia is possible after the disease has been overcome. However, recurrence of skin ulceration and reinfection is possible.
  • Typhoid tularemia: Sickness and gastrointestinal symptoms. Complicating pneumonia with respiratory distress may occur.
  • Allergic tularaemia: The tularaemia may be accompanied by polymorphous exanthema, sometimes scarlatina-like, also papulo-pustular or papulo-ulcerous. Nodular rashes are also possible.

DiagnosisThis section has been translated automatically.

Microscopic or cultural pathogen detection. The serum agglutination test is positive from about the second week of illness. A skin test with Francisella tularensis antigen is already positive in the first week of illness.

Differential diagnosisThis section has been translated automatically.

Ecthyma, actinomycosis, anthrax of the skin, syphilis I, boils, sporotrichosis, plague, malleus, lymphogranuloma inguinale, tuberculosis of the skin.

Complication(s)This section has been translated automatically.

Lung abscess, meningitis, mediastinitis.

External therapyThis section has been translated automatically.

Symptomatic therapy with moist compresses, e.g. with polihexanide (Serasept, Prontoderm), potassium permanganate solution(light pink), quinolinol (e.g. quinosol 1:1000 or R042 ) or lotio alba, possibly with the addition of 2% clioquinol R050.

Notice! Early therapy is important because 1-5% of patients die if not treated adequately!

Internal therapyThis section has been translated automatically.

Drug of the 1st choice is streptomycin (e.g. Streptomycin Grünenthal) 2 times/day 0.5-1.0 g/day i.m. over 10 days, if necessary longer, in the full picture up to 25-30 mg/kg bw, including normalization of fever within the first 3-7 days, decrease of skin changes and lymphadenopathy over weeks.

As alternative antibiotics (especially for streptomycin resistance) spiramycin (e.g. selectomycin) 2-3 g/day p.o. for 7-14 days, gentamicin (e.g. re-fobacin) 3 mg/kg bw/day as i.m. injection, tetracycline (e.g. tetracycline Wolff) 3 times/day 500 mg p.o., erythromycin (erythro-hefa) 1.5-2 g divided into 2-3(-4) ED or ciprofloxacin 2 times/day 500 mg p.o.

Note(s)This section has been translated automatically.

The name tularemia comes from the place where the pathogen was first found, Tulare in California.

LiteratureThis section has been translated automatically.

  1. Faber M et al. (2018) Tularemia in Germany-A Re-emerging Zoonosis.Front Cell Infect Microbiol 8:40.
  2. Jensen WA, Kirsch CM (2003) Tularemia. Semin Respir Infect 18: 146-158
  3. McCoy GW, Chapin CW (1912) Further observations on a plague-like disease of rodents with a preliminary note on the causative agent, Bacterium tularense. J Infect Dis 10: 61-72
  4. McGinley-Smith DE, Tsao SS (2003) Dermatoses from ticks. J Am Acad Dermatol 49: 363-392
  5. Singh-Behl D et al (2003) Tick-borne infections. Dermatol Clin 21: 237-244
  6. Wherry WB, Lamb BH (1914) Infection of man with Bacterium tularense. J Infect Dis 15: 331-340

Authors

Last updated on: 30.03.2021

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. med. Ouadie El Makhtoum