Tularemia is a zoonotic bacterial disease caused by the bacterium Franciscella tularensis. The disease has a variety of clinical manifestations related to the route of introduction and the virulence of the organism.

The clinical manifestations of tularemia are :

• Ulceroglandular (cutaneous ulcer with regional lymphadenopathy) (most common form)
• Glandular (regional lymphadenopathy with no ulcer)
• Oculoglandular (conjunctivitis with regional lymphadenopathy)
• Oropharyngeal (stomatitis or pharyngitis or tonsillitis and cervical lymphadenopathy)
• Intestinal (intestinal pain, vomiting, and diarrhea)
• Pneumonic (primary pleuropulmonary disease)
• Typhoidal (febrile illness without early localizing signs and symptoms)

Numerous wild animals, especially rabbits, hares, voles, muskrats, beavers, and some domestic animals are the reservoir for the bacteria. The disease is transmitted through the bite of certain ticks and deer flies, or by contact of the skin with contaminated water, blood or tissue while handling carcasses of infected animals.

Tularemia could be developed for use in bioterrorism, particularly if used as an aerosolized agent. Cases acquired by inhalation would present as a primary pneumonia.

The incubation period is usually 3 to 5 days and ranges from 1 to 14 days.

Laboratory diagnosis is confirmed by isolation of F. tularensis in a clinical specimen or a fourfold or greater change in serum antibody titer to F. tularensis antigen.

For sending specimens to the Central Public Health Laboratory, physicians must call 416-235-6100 during work hours and 416-605-3113 after work hours prior to submission.

Specimens should be handled according to universal precautions and packaged for transport to the Central Public Health Laboratory according to the Transportation of Dangerous Good regulation.

Streptomycin or gentamycin given for 7 to 14 days is the drug of choice.

Tularemia is a reportable disease in Ontario under the Health Protection and Promotion Act and must be reported immediately to the local medical officer of health by telephone. The disease should be reported even if it is only suspected and has not yet been confirmed.

References

The information provided is subject to change. The information was collated from the following three sources :

1. Chin, J. "Control of Communicable Diseases Manual". 17th Edition. 2000. American Public Health Association: Washington D.C.
2. Health Canada website
3. Centers for Disease Control and Prevention website

*Advice on the most up-to-date treatment should be sought from a clinical expert.

January 2003