tularemia, infectious dx

1. SENIOR NURSE
LECTURE
SERIES
TULAREMIA

2. DEFINITION
 Tularemia is a rare infectious disease that can attack the skin,
eyes, lymph nodes, lungs and, less often, other internal
organs. Often called rabbit fever or deer fly fever, tularemia is
caused by the bacterium Francisella tularensis. The disease
mainly affects mammals, especially rodents, rabbits and
hares, although it can also infect birds, reptiles and fish.
 Tularemia spreads to humans through several routes,
including insect bites and direct exposure to an infected
animal. Highly contagious and potentially fatal, tularemia
usually can be treated effectively with specific antibiotics if
diagnosed early.

3. SIGNS & SYMPTOMS
 Most people exposed to tularemia who become
sick generally do so within two to 10 days.
Several types of tularemia exist, and which type
you get depends on how and where the
bacteria enter the body. Most commonly, they
enter through skin or mucous membranes, but
they can also be inhaled or eaten. Each type of
tularemia has its own set of symptoms.

4. SETS OF SIGNS & SYMPTOMS
 Ulceroglandular tularemia
 This is by far the most common form of the disease. Signs and
symptoms include:
 A skin ulcer that forms at the site of infection — usually an insect or
animal bite
 Swollen and painful lymph glands
 Fever
 Chills
 Headache
 Exhaustion

5. SETS OF SIGNS & SYMPTOMS
 Glandular tularemia
 People with glandular tularemia have the same
signs and symptoms of ulceroglandular
tularemia, except no skin ulcers.

6. SETS OF SIGNS & SYMPTOMS
 Oculoglandular tularemia
 This form affects the eyes and may cause:
 Eye pain
 Eye redness
 Eye swelling and discharge
 An ulcer on the inside of the eyelid

7. SETS OF SIGNS & SYMPTOMS
 Oropharyngeal tularemia
 Usually caused by eating poorly cooked wild animal meat or
drinking contaminated water, this form affects the digestive tract.
Signs and symptoms include:
 Fever
 Sore throat (pharyngitis)
 Mouth ulcers
 Vomiting
 Diarrhea

8. SETS OF SIGNS & SYMPTOMS
 Pneumonic tularemia
 More common in the elderly and in people with typhoidal
tularemia, this causes signs and symptoms typical of pneumonia:
 Cough
 Chest pain
 Difficulty breathing
 Other forms of tularemia also can spread to the lungs.

9. SETS OF SIGNS & SYMPTOMS
 Typhoidal tularemia
 This rare and serious form of the disease usually causes:
 High fever
 Extreme exhaustion
 Vomiting and diarrhea
 Enlarged spleen (splenomegaly)
 Enlarged liver (hepatomegaly)
 Pneumonia

10. CAUSES
 Insect bites. Although a number of insects carry tularemia, ticks and deer flies
are most likely to transmit the disease to humans. Tick bites cause a large
number of cases of ulceroglandular tularemia.
 Exposure to sick or dead animals. Ulceroglandular tularemia can also result
from handling or being bitten by an infected animal, most often a rabbit or
hare. Bacteria enter the skin through small cuts and abrasions or a bite, and an
ulcer forms at the wound site. The ocular form of tularemia can occur when you
rub your eyes after touching an infected animal.
 Airborne bacteria. Bacteria in the soil can become airborne during gardening,
construction or other activities that disturb the earth. Inhaling the bacteria can
lead to pneumonic tularemia. Laboratory workers who work with tularemia also
are at risk of airborne infection.

11. CAUSES
 Contaminated food or water. Although uncommon, it's
possible to get tularemia from eating undercooked meat
of an infected animal or drinking contaminated water.
The signs include vomiting, diarrhea and other digestive
problems (oropharyngeal tularemia). Heat kills F.
tularensis, so cook meat to the right temperature — a
minimum of 160 F (71.1 C) for pork and ground meat and
game meat, 145 F (62.8 C) for farm-raised steaks and
roasts — to make it safe to eat.

12. CULPRIT

13. RISK FACTORS
 Living in or visiting certain areas
 Having certain hobbies or occupations

14. COMPLICATIONS
 Inflammation of the lungs (pneumonia).
 Infection around the brain and spinal cord
(meningitis).
 Irritation around the heart (pericarditis).
 Bone infection (osteomyelitis).

15. PREVENTION
 Attempts to develop a tularemia vaccine have not been
successful so far. If you work in a high-risk occupation or live in an
area where tularemia is present, these measures may help reduce
your chance of infection:
 Protect yourself from insects.
 Use an insect repellent.
 Take care when gardening.
 Handle animals carefully.
 Protect your pets.

16. SENIOR NURSE LECTURE SERIES
PRESENTED BY:
JOEL P. DANTE R.N.
CODE & TRAUMA SENIOR NURSE
EMERGENCY DEPARTMENT
CCMC