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May stop additional isolation when:
lesion no longer drains
Symptoms
Local ulcer and regional lymphadenophathy, fever, chills, headache,
malaise, substernal discomfort, prostration, weight loss, and no
production cough.
Comments:
Tularemia is caused by a small gram-negative coccobacillus, Francisella
tularensis. Two serotypes, Jellison type A and Jellison Type B, are
recognized. Jellison Type A has much higher mortality (5-15%) than
Type B, which rarely causes fatalities even in untreated cases.
Disease manifestation relates to mode of exposure.
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Incubation Period
1-14 days, usually 3-5 days. Route and dose dependant.
Period of Communicability
No person to person transmission. Numerous wild animals are the
reservoir. Flies are infectious for up to 2 weeks, ticks are
infectious for life, in blood, two weeks and in lesions, 1 month.
Label all cultures sent to prevent exposure in the lab. Lab personnel
must work under a hood in the lab.
Cohort (Inf. with Inf./Exp. with Exp./Non-Exp. with Non-Exp.)
Not Required
Transport Issues
Carefully label all cultures sent to prevent exposure in the lab
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Who’s susceptible
General. Infection produces protective immunity. However, re-infection can occur
Who’s exposed
By bite of an arthropod (ticks, deer flies, and mosquitoes). Skin or
mucus membrane exposure to contaminated water, handling infected
material or animals, such as rabbits, food, or inhalation of
contaminated dust.
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Exclusion of symptomatic personnel from duty
Yes, until fit to work.
Exclusion of exposed susceptible personnel from duty
Not Required
Isolation of exposed susceptible asymptomatic patients
Not Required
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Prophylaxis for exposed
Doxycycline 100 mg PO BID x 14 days or Ciprofloxin 500 mg PO BID
Treatment for the Ill
Gentamycin 5 mg/kg IM or IV qd or Streptomycin 1gm IM BID (if available)
or Doxycyline 100 mg IV/PO BID. Treat for 10-14 days.
Military/Institutional Populations Special Issues
Use repellent and nets, check for ticks. Can be aersolized and used
as a biological warfare agent.
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