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EMS AND DISASTER MEDICINE^910


TREATMENT
■ Isolate patient.
■ Very contagious until all scabs fall off
■ Exposed persons →vaccinate within 3 days to prevent or attenuate disease.
■ Vaccinia immunoglobulin is given simultaneously with vaccine and
redosed as needed to limit complications of vaccination.
■ Antivirals are being investigated as treatment.

Tularemia

Organism:F. tularensis, a Gram-negative intracellular bacterium

Tularemia (commonly called “rabbit fever”) is transmitted primarily from
ticks, lagomorphs, and rodents via direct contact or ingestion of infected
water, soil, or fomites.

Several forms exist depending on route of contact:
■ Localized diseasewith regional lymph node involvement:
■ Ulceroglandular: Most common
■ Glandular: Second most common
■ Oculoglandular
■ Oropharyngeal
■ Invasive and generalized disease:
■ Typhoidal
■ Pulmonary

SYMPTOMS/EXAM
■ Multiple presentations are possible depending upon which form is present
(see Table 20.10).

TABLE 20.10. Clinical Findings in Tularemia

Localized Disease

Ulceroglandular disease Ulcerated skin lesion
Regional (sometimes generalized) lympadenopathy
Fever

Glandular tularemia Regional lymphadenopathy without skin lesion

Oculoglandular tularemia Conjunctivitis with preauricular adenopathy

Oropharyngeal tularemia Severe pharyngitis with cervical lymphadenitis

Invasive and Generalized Disease

Typhoidal tularemia Fevers, chills
GI symptoms
No skin lesions

Pulmonary tularemia Fevers, chills
Nonproductive cough, shortness of breath

The most common form of
Tularemia =ulcerogladular.

Vaccinia immunoglobulin is
given to limit the
complications of smallpox
vaccination (not disease).
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