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Chapter 12 : Tularemia
Category: Clinical Microbiology
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Tularemia is a disease caused by infection with the bacterium Francisella tularensis. The disease is manifested by a broad range of signs and symptoms that include one or more of the following: an ulcer at the initial site of infection, regional lymphadenopathy, fever, chills, headache, malaise, sore throat, cough, abdominal pain, vomiting, diarrhea, and, in severe forms, dyspnea and septic shock. Primary or secondary pneumonia may occur following inhalation of F. tularensis or after dissemination to the lung from other infected sites, respectively. This chapter first discusses the etiologic agent and biology of F. tularensis. Then, it talks about the role of ticks in transmission of F. tularensis. Tularemia is notable among infectious diseases for its high infectivity and many routes of transmission, yet surprisingly it is not contagious between people. Humans can acquire tularemia by handling, skinning, eating, or being scratched or bitten by infected vertebrates; handling or being bitten by infected arthropods; drinking contaminated water; making skin contact with contaminated mud or water; or inhaling infective aerosols. The clinical manifestations of tularemia depend on the route and mechanism of inoculation, the virulence of the infecting bacterial strain, and the host response of the infected person. Next, the chapter describes six primary clinical syndromes of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic, and typhoidal. The chapter ends with a discussion on diagnosis, treatment, and prevention of tularemia.