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Tularemia (Rabbit Fever/Deer Fly Fever)

Tularemia (Rabbit Fever/Deer Fly Fever)

Diagnosis

1.
F/C, HA, malaise

2.
Ulceroglandular: local ulcer and regional adenopathy

3.
Typhoidal and pulmonary forms:

4.
Most likely bioterrorism forms

5.
Aerosol exposure

6.
F/C, HA, weight loss, non-productive cough

7.
CXR: pneumonic process in 1 or more lobes (positive in 25-50% in early stages), mediastinal adenopathy or pleural effusion

8.
Routine culture possible; takes up to 10 d

9.
Established retrospectively by serology
History

1.
First recognized in Tulare County, California

2.
Found in Japan in 1800’s and in Russia in 1926
Pathophysiology

1.
Francisella tularensis: small, aerobic non-motile, gram-negative cocco-bacillus

2.
Contact of skin or mucous membranes with tissues or body fluids of infected animals, or bites of infected deerflies, mosquitoes, or ticks

3.
Hunters and wilderness area visitors

4.
Viable for wks in water, soil, carcasses, hides; for yrs in frozen rabbit meat

5.
Incubation: 2-10 d

6.
Killed by heat and disinfectants
Prevention

1.
Live, attenuated vaccine: 1 dose by scarification

2.
PEP: Ciprofloxacin 500 mg PO bid OR doxycyline 100 mg PO bid
Isolation/Decontamination

1.
Standard precautions for healthcare workers

2.
Destroyed by 55 deg C for 10 mins and standard disinfectants
Treatment

1.
Ciprofloxacin 500 mg PO bid OR doxycyline 100 mg PO bid for 14 d

2.
Alt: streptomycin 1-2 g IM in divided equal doses for 7-14 d until afebrile for 5-7 d

3.
Child:

If >45 kg: doxycycline 100 mg PO bid

If <45 kg: 2.2 mg/kg PO bid

Ciprofloxacin 15 mg/kg PO bid
Disposition

1.
Admit; standard precautions

2.
Notify CDC & local health dept

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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