EMS AND DISASTER MEDICINE■ In localized disease:
■ Ulcerated skin (see Figure 20.9), conjunctivitis, or pharyngitis with
associated regional lymphadenopathy, or
■ Regional lymphadenopathy alone
■ Typhoidal tularemia:
■ Fevers, chills, GI symptoms without skin lesions
■ Pulmonary tularemia:
■ Fevers, chills, nonproductive cough, shortness of breath
DIAGNOSIS
■ Based on clinical findings
■ Antibody titers, rapid PCR
TREATMENT
■ Isolation is notrequired.
■ Antibiotic: Streptomycin is drug of choice.
■ Prophylaxis=doxycycline.
Viral Hemorrhagic Fever
Organisms: Filoviruses and arenaviruses
Normally transmitted via mosquitoes, rodents, or their parasites
SYMPTOMS/EXAM
■ Incubation period from 4 to 21 days, followed by:
■ Fevers, myalgias, prostration
■ Petechial hemorrhage, DIC
■ Multisystem organ dysfunction, cardiovascular collapse
FIGURE 20.9. Tularemia: Ulcerated skin lesion.
(Courtesy of the CDC.)