Francisella tularensis: Difference between revisions

Revision as of 15:59, 8 November 2019

Zoonontic infection carried on rodents and rabbits and transmitted by biting insects
Presentation depends on route of entry: (ulcero)glandular, oculoglandular, pharyngeal, typhoidal, or pneumonic
Treatment is streptomycin

Background

Microbiology

A fastidious Gram-negative coccobacillus

History

Discovered in 1911 in Tulare county, California
Many names: deer fly fever, rabbit fever, etc...

Epidemiology

Zoonotic infection whose main animal reservoirs are rodents and rabbits
Essentially worldwide Northern Hemisphere distribution, especially in the US, Japan, Russia, and Scandinavian countries
Transmission:
- Bite of ticks, biting flies, or mosquitoes (Europe)
- Exposure to animal products, including skinning, dressing, and eating wild game
- Also from animal stool or bites, including cats that have killed infected rodents

Clinical Presentation

Ulceroglandular: ulcer develops at site of inoculation with tender lymphadenopathy and systemic symptoms
Glandular: ulcer is undetectable or healed, only lymphadenopathy and systemic illness remains
Oculoglandular: entry through the conjuctiva
Pharyngeal: entry through the oropharynx, with exudative pharyngitis/tonsillitis
Typhoidal: febrile illness without lymphadenopathy or ulcer, sometimes with diarrhea; patient often has an underlying chronic disease
Pneumonic: direct inhalation, often from sheep shearing, landscaping, and microbiology laboratory work

Diagnosis

Culture
- Grows slowly on standard culture media, needs cystine-rich media (e.g. chocolate agar, BHI, or cystine media)
- Looks bacillary in logarithmic growth phase (small Gram-negative rod), slow-growing only on chocolate agar
Serology (EIA) can be used in the right context
PCR

Management

Streptomycin IM if severe (amikacin/other AG IV here) x2wks
Doxycycline or ciprofloxacin if mild, x2wks

@@ Line 1: / Line 1: @@
-* Zoonontic infection of a fastidious Gram-negative coccobacillus, carried on rodents &amp; rabbits and transmitted by biting insects
+* Zoonontic infection carried on rodents and rabbits and transmitted by biting insects
 * Presentation depends on route of entry: (ulcero)glandular, oculoglandular, pharyngeal, typhoidal, or pneumonic
-* Treatment is streptomycin for __ weeks
+* Treatment is streptomycin
-== Definition ==
+== Background ==
+=== Microbiology ===
-* Zoonotic infection with ''Francisella tularensis'', a fastidious Gram-negative coccobacillus
+* A fastidious [[Has Gram stain::Gram-negative]] [[Has shape::coccobacillus]]
-* Also called rabbit fever
-== History ==
+=== History ===
 * Discovered in 1911 in Tulare county, California
-* Deer fly fever, rabbit fever, etc...
+* Many names: deer fly fever, rabbit fever, etc...
-== Syndromes ==
-# '''Ulceroglandular:''' ulcer develops at site of inoculation with tender lymphadenopathy and systemic symptoms
-# '''Glandular:''' ulcer is undetectable or healed, only lymphadenopathy and systemic illness remains
-# '''Oculoglandular:''' entry through the conjuctiva
-# '''Pharyngeal:''' entry through the oropharynx, with exudative pharyngitis/tonsillitis
-# '''Typhoidal:''' febrile illness without lymphadenopathy or ulcer, sometimes with diarrhea; patient often has an underlying chronic disease
-# '''Pneumonic:''' direct inhalation, often from sheep shearing, landscaping, and microbiology laboratory work
-== Epidemiology ==
+=== Epidemiology ===
+* Zoonotic infection whose main animal reservoirs are rodents and rabbits
 * Essentially worldwide Northern Hemisphere distribution, especially in the US, Japan, Russia, and Scandinavian countries
+* Transmission:
-* Main animal reservoirs are rodents and rabbits
-* Transmission
 ** Bite of ticks, biting flies, or mosquitoes (Europe)
 ** Exposure to animal products, including skinning, dressing, and eating wild game
 ** Also from animal stool or bites, including cats that have killed infected rodents
+== Clinical Presentation ==
+* '''Ulceroglandular:''' ulcer develops at site of inoculation with tender lymphadenopathy and systemic symptoms
+* '''Glandular:''' ulcer is undetectable or healed, only lymphadenopathy and systemic illness remains
+* '''Oculoglandular:''' entry through the conjuctiva
+* '''Pharyngeal:''' entry through the oropharynx, with exudative pharyngitis/tonsillitis
+* '''Typhoidal:''' febrile illness without lymphadenopathy or ulcer, sometimes with diarrhea; patient often has an underlying chronic disease
+* '''Pneumonic:''' direct inhalation, often from sheep shearing, landscaping, and microbiology laboratory work
 == Diagnosis ==
+* Culture
-* Culture: Grows slowly on standard culture media, needs cystine-rich media (e.g. chocolate agar, BHI, or cystine media)
+** Grows slowly on standard culture media, needs cystine-rich media (e.g. chocolate agar, BHI, or cystine media)
 ** Looks bacillary in logarithmic growth phase (small Gram-negative rod), slow-growing only on chocolate agar
 * Serology (EIA) can be used in the right context
 * PCR
-== Presentation ==
-* Based primarily on route of entry (see Syndromes, above)
 == Management ==
+* [[Is treated by::Streptomycin]] IM if severe ([[Is treated by::amikacin]]/other AG IV here) x2wks
+* [[Is treated by::Doxycycline]] or [[Is treated by::ciprofloxacin]] if mild, x2wks
-* Streptomycin IM if severe (amikacin/other AG IV here) x2wks
-* Doxy or cipro if mild, x2wks
 {{DISPLAYTITLE:''Francisella tularensis''}}