Tularemia is a zoonosis that most commonly causes an ulceroglandular disease in humans exposed to diseased animal fluids or bites from infected deerflies, mosquitoes, or ticks. Typhoidal or septicemic forms can occur following inhalation of the inciting organism, Francisella tularensis. While not highly fatal, both its extremely high infectivity and ability to escape laboratory detection make this a likely terrorist agent. Infectivity by the inhalation route approaches 100 percent, with an untreated mortality of 35 percent. Only 10 to 50 organisms are required for an infection. Following a 2- to 10-day incubation period, fever, prostration, chest pain, and dry cough develop. Patchy infiltrates and hilar adenopathy may be seen on chest x-ray. The diagnosis is confirmed by serology. Antibiotic treatment includes streptomycin 1 g IM every 12 h for 14 days (30 mg/kg per day) or gentamicin 3 to 5 mg/kg per day. Prophylaxis with oral tetracycline or doxycycline for 14 days is recommended for those exposed. Immunity following tularemia is permanent. Person-to-person transmission does not occur, and respiratory isolation is not required. Standard precautions should be sufficient in protecting health care professionals.

Dealing With Back Pain

Dealing With Back Pain

Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.

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