Tularemia

Summary

Zoonontic infection of a fastidious Gram-negative coccobacillus, carried on rodents & rabbits and transmitted by biting insects
Presentation depends on route of entry: (ulcero)glandular, oculoglandular, pharyngeal, typhoidal, or pneumonic
Treatment is streptomycin for __ weeks

Zoonotic infection with Francisella tularensis, a fastidious Gram-negative coccobacillus
Also called rabbit fever

Ulceroglandular: ulcer develops at site of innoculation 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

Essentially worldwide Northern Hemisphere distribution, especially in the US, Japan, Russia, and Scandinavian countries
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

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