Tularemia

Tularemia is an illness caused by the bacteria Francisella tularensis. It can cause several symptoms, including swollen lymph nodes, ulcers on the skin, and problems in the lungs, eyes, throat, and intestines.

How You Can get Tularemia

Tularemia is a zoonotic disease, meaning it can spread from animals to humans. Here are some common ways people get infected:

• Insect Bites: Bites from infected deer flies or ticks can transmit the bacteria.
• Animal Contact: Touching infected animals, especially rabbits, hares, and rodents, can spread the bacteria. This can happen through hunting, handling uncooked meat, or working with animals.
• Contaminated Food or Water: Eating or drinking contaminated sources can introduce bacteria into your body. For instance, Ingesting polluted water or food, like meat that hasn’t been cooked thoroughly,

Symptoms of tularemia:

The most noticeable symptom is swollen lymph nodes, which appear as large bumps under the skin. In some cases, an open sore (ulcer) may develop at the infection site.

Who is most at risk?

Anyone can contract tularemia, but certain activities or professions can increase your risk:

• Hunters and Meat Handlers: Handling wild game or uncooked meat can expose you to bacteria.
• Animal Professionals: Veterinarians, animal control officers, and anyone working with animals are at higher risk.
• People Exposed to Biting Insects: Spending time outdoors in areas with deer flies or ticks can increase your risk.
• Individuals with Weak Immune Systems: People with HIV, cancer, or taking immunosuppressant medications are more susceptible.
• Farm Workers and Lab Workers: Working with animals or bacteria in a lab environment can lead to a specific type of tularemia affecting the lungs (pneumonic tularemia).
• Location: Cases are most commonly reported in the central US, particularly Arkansas, Oklahoma, Missouri, Nebraska, South Dakota, and Kansas.

How Common is Tularemia?

It is a relatively rare disease, with fewer than 300 reported cases annually in the US. While it can occur in any state except Hawaii, it’s most concentrated in the south-central US, the Great Plains, and parts of Massachusetts.

What Parts of the Body Does Tularemia Affect?

The bacteria can infect various parts of your body, including:

• Lymph nodes
• Skin
• Eyes
• Throat
• Intestines
• Lungs (in severe cases)
• Other organs (rarely, including the brain and heart)

How Does Tularemia Work?

The bacteria enter your body and are initially engulfed by immune system cells. However, instead of being destroyed, the bacteria multiply inside these cells, ultimately causing them to burst and spread the infection further. This destruction and the immune system’s response lead to symptoms in the infected area.

Types of Tularemia

Tularemia, caused by the bacteria Francisella tularensis, can manifest in several ways, depending on how you were infected. Here’s a breakdown of the different types of tularemia:

• Ulceroglandular Tularemia (Most Common): This is the most frequent type, usually transmitted through tick bites or infected animal contact. It affects both your skin and lymph nodes, causing sores and swelling in those areas.
• Glandular Tularemia: Similar to ulceroglandular tularemia, but without skin sores. It can be contracted through tick bites or direct contact with infected animals, leading to swollen lymph nodes.
• Oculoglandular Tularemia (Eye Trouble): This type arises from contaminated water or fluids getting in your eye. Symptoms like redness, swelling, and discomfort affect the infected eye (usually only one).
• Oropharyngeal Tularemia (Throat and Gut): Eating or drinking contaminated food/water or touching your mouth with unwashed hands can lead to oropharyngeal tularemia. It causes a sore throat and sometimes digestive problems.
• Pneumonic Tularemia (Most Serious): This is the most severe form, causing symptoms resembling pneumonia. You can contract it by inhaling F. tularensis or when the bacteria spreads to your lungs from another infected area.
• Typhoidal Tularemia (Full-Body Attack): The most serious form after pneumonic, typhoidal tularemia brings high fever and affects multiple body parts. It can be contracted in various ways, similar to other tularemia types.

Tularemia vs. Lyme Disease

While some symptoms of tularemia and Lyme disease overlap, they impact the body differently. Tularemia can affect various organs and potentially be life-threatening. Lyme disease, although causing long-term discomfort in some cases, isn’t usually life-threatening.

Tularemia Symptoms

This bacterial infection can cause a variety of symptoms, depending on how you contracted it. Here’s a breakdown of the signs and symptoms based on the infected area:

Ulceroglandular and Glandular Tularemia:

• Fever is a telltale sign of infection.
• Swollen lymph nodes: expect large, painful lumps near the infection site.
• Skin Ulcer (Ulceroglandular only): An open sore might appear on your skin.

Oculoglandular Tularemia:

• Eye Trouble: This form affects your eyes, causing pain, watery eyes, and sensitivity to light.
• Swollen lymph nodes: painful lumps might appear around your ears or neck.
• Eye Sore: In severe cases, an open sore might develop on your cornea.

Oropharyngeal Tularemia:

• Fever: unexplained rise in body temperature.
• Sore Throat: Expect a severe sore throat.
• Swollen Throat: Your throat might be red and swollen, with white patches.
• Digestive Issues: Some people experience vomiting, diarrhea (possibly bloody), and abdominal pain.

Pneumonic Tularemia:

• Respiratory Problems: This form attacks the lungs, causing fever, cough, shortness of breath, chest pain, and tightness.
• Muscle Aches: General muscle aches are common.
• Skin Rash: A red, bumpy rash (erythema nodosum) might appear.
• Coughing Up Blood: In severe cases, coughing up blood might occur.

Typhoidal Tularemia:

This is the most severe form, with flu-like symptoms including:

• High Fever
• Chills
• Headache
• Loss of Appetite
• Muscle Aches
• Sore Throat
• Abdominal Pain
• Diarrhea
• Nausea or Vomiting
• Confusion

Diagnosis of Tularemia

The first step involves a thorough examination. Your doctor will ask about your symptoms and any potential exposures to tularemia (like tick bites or contact with infected animals) and take a close look at your body. This might include checking your lymph nodes, throat, eyes, and any skin lesions like ulcers, bumps, or rashes.

Tests to confirm the diagnosis:

Here are the tests and procedures your provider might employ to diagnose tularemia:

1. Blood Tests: A blood sample will be collected from your arm and sent to a laboratory. The lab will analyze the sample for signs of tularemia and may attempt to culture the Francisella tularensis bacterium. Initially, your blood test results may appear normal because F. tularensis can be slow to grow. You might need to repeat blood tests after a few weeks.
2. Biopsy: If you have enlarged lymph nodes or ulcers, your provider may perform a biopsy, extracting a sample of tissue for analysis. The laboratory will test the sample for F. tularensis or attempt to culture the bacterium from it.
3. Nasal or Throat Swab: Using a soft-tipped swab, your provider may collect a mucus sample from your nose or throat. The sample will be sent to a lab for testing for F. tularensis or attempted culture.
4. Pleural Fluid Test (Thoracentesis): If you have fluid accumulation around your lungs, a thoracentesis procedure may be performed to collect a sample. The lab will then test the sample for F. tularensis or attempt to culture the bacterium from it.

Treatments of Tularemia

This potentially serious bacterial infection requires prompt treatment with antibiotics. Don’t wait for test results; your doctor might start you on antibiotics right away to prevent complications. Here’s what you need to know about treating tularemia:

Doctors typically use broad-spectrum antibiotics to wipe out the bacteria causing tularemia. These antibiotics can be administered in two ways:

• Intravenous (IV): Delivered directly into a vein through a needle, this method is faster-acting and preferred for severe cases.
• Oral: Available as pills, oral antibiotics are a convenient option for less severe cases.

Here are some of the commonly used antibiotics for tularemia:

• Streptomycin
• Gentamicin
• Doxycycline
• Azithromycin
• Ciprofloxacin or Levofloxacin

Home Care Tips:

Antibiotics are crucial, but you can also play an active role in your recovery.

• Complete the Antibiotic Course: Even if you feel better, take all prescribed antibiotics until the end. Stopping early can allow bacteria to survive and cause a relapse.
• Manage Symptoms at Home: Some symptoms, like fever or muscle aches, can be managed at home. Talk to your doctor about over-the-counter pain relievers or other remedies that might be safe for you.

Prevention of Tuaremia

Here’s how to minimize your risk:

Protect Yourself from Bug bites.

• Cover Up: When outdoors, especially in areas with tall grass or woods, wear clothes that cover most of your skin.
• Bug Spray: Use insect repellent containing DEET to deter ticks and other biting insects.
• Tick Check: After spending time outside, check yourself and your pets thoroughly for ticks, especially in hard-to-reach areas like the scalp. Consider having someone else help with the inspection.

Pet Care and Safety:

• Tick Prevention for Pets: Ask your veterinarian about tick prevention methods for your furry companions. Remember, outdoor cats can also contract tularemia.
• Supervise Pets Outdoors: Keep an eye on your pets while they’re outside to minimize their risk of bites from infected animals. Bites from other animals can transmit tularemia as well.
• Safe Animal Handling: Always wear gloves when handling animals, both alive and dead. Avoid touching wild animals with your bare hands. Wash your hands thoroughly after any contact with animals, even if you were wearing gloves.

Food Safety:

• Cook Meat Thoroughly: Ensure all meat is cooked to safe internal temperatures to kill any harmful bacteria, including those that cause tularemia.
• Cleanliness in the Kitchen: Always wash your hands, surfaces, and utensils thoroughly after preparing food. This is especially important when handling game meat, which can harbor tularemia bacteria.

Water and Animal Carcasses:

• Drink Safe Water: Avoid drinking untreated water, especially from potentially contaminated sources.
• Minimize Contact with Carcasses: If possible, avoid mowing or using machinery near animal carcasses. If you must move a carcass, wear protective gear. While wearing a mask during mowing or using agricultural equipment might help prevent inhaling airborne particles, more research is needed to confirm this benefit.

Antibiotics for Potential Exposure:

If you suspect you’ve been exposed to tularemia, talk to your doctor about the possibility of taking preventive antibiotics to reduce your chances of becoming sick.

Recovery Timeline

• Antibiotics for 10–21 Days: You’ll likely be on antibiotics for about two to three weeks to fight the infection.
• Feeling Better: While treatment typically takes two to three weeks, it might take longer to feel completely back to yourself.
• Rashes and Scarring: Rashes caused by tularemia might leave permanent scars, but this doesn’t happen in all cases.

Doctor Monitoring

Depending on the severity of your symptoms and how long you’ve been sick, your doctor may monitor you closely for the first few days of treatment, especially if you started experiencing symptoms before getting antibiotics.

Relapse: In some cases, symptoms may return after you start feeling better. If this happens, you may need another round of antibiotics.

Complications of Tularemia

Tularemia complications often arise from pneumonic (lung) or typhoidal (widespread) forms of the disease. These complications can include:

• Acute Respiratory Distress Syndrome (ARDS): This life-threatening condition hinders your lungs’ ability to deliver oxygen throughout the body.
• Brain Inflammation: Meningitis (inflammation of the membranes surrounding the brain and spinal cord) or meningoencephalitis (inflammation of the brain itself) can occur.
• Heart Inflammation: Myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the sac surrounding the heart), or endocarditis (inflammation of the inner heart lining) are possible complications.
• Bone and Joint Issues: Osteomyelitis (bone infection) or arthritis (joint inflammation) could develop.
• Liver Damage: Hepatitis, or liver inflammation, can occur.
• Kidney Failure: Your kidneys may struggle to function properly.
• Internal Bleeding (Hemorrhage): Bleeding within the body can have serious consequences.

Importance of Early Treatment

While some individuals might recover from tularemia without antibiotics, it’s a risky gamble. Untreated cases can lead to severe complications, potentially causing organ damage. In its most severe form (type A), the fatality rate can reach 30% without antibiotics.

Living with Tularemia

When to See a Doctor:

• If you experience tularemia symptoms,.
• If you suspect exposure to tularemia,. Your doctor might recommend preventive antibiotics.
• If symptoms resurface during or after treatment,.

Seek immediate medical attention for any signs of severe illness.

• High fever (over 103°F or 39.4°C)
• Confusion or mental changes
• Blood in vomit or stool
• Coughing up blood
• Bluish skin, lips, or nails (a sign of oxygen deprivation)
• Severe abdominal pain
• Sudden or severe shortness of breath

Returning to Normal Life:

Tularemia isn’t contagious from person to person, so you shouldn’t have to worry about spreading it to others. Once you feel well enough, you can safely return to work or school.

Overall Prognosis:

With prompt treatment, the outlook for tularemia is very positive! Less than 1% of treated cases result in death.

Tularemia FAQs

How Soon Will I Know If I’m Infected?

The incubation period for tularemia is typically 3-5 days, but it can take up to two weeks for symptoms to appear. So, if you think you might have been exposed, be aware that it could take some time before you feel unwell.

What causes tularemia?

The culprit behind tularemia is a bacterium called Francisella tularensis. This bacteria lives in animals, particularly rabbits, hares, rodents, and even some cats. Ticks and biting insects can also carry it. There are two types of F. tularensis:

• Type A: This type causes a more severe illness and is found in the United States.
• Type B: This type causes milder symptoms and is found in North America and most other parts of the world.

How Can I Get Tularemia?

This bacterial infection is spread in several ways:

• Insect Bites: Ticks, mosquitos, deer flies, and other biting insects can transmit the bacteria.
• Animal Bites or Contact: Bites from infected animals or even touching their infected tissue or fluids can introduce the bacteria into your body. Be careful not to touch your face after contact with potentially infected animals.
• Contaminated Food or Water: Drinking contaminated water or eating contaminated food can also cause tularemia.
• Inhalation: Inhaling an aerosol mist containing F. tularensis, which can happen if you mow over an infected animal, is a less common way to contract the disease.

Is Tularemia Contagious?

The good news is that tularemia is not contagious from person to person. However, it’s highly infectious. This means that even small amounts of the bacteria can make you sick.

Is tularemia curable in humans?

Yes, tularemia is indeed curable in humans, as antibiotics are effective in killing the bacteria responsible for the infection.

Can I eat meat from an animal with tularemia?

While cooking food to a safe temperature kills most bacteria, it’s best to avoid eating meat from an animal you know or suspect has tularemia.

Sources:

1. Centers for Disease Control and Prevention (CDC): “Tularemia.”
2. Mayo Clinic: “Tularemia.”
3. San Francisco Department of Public Health: “Tularemia.”
4. Clevland Clinic, “Tularemia.”