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.
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