0071643192.pdf

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).