{"id":1894,"date":"2009-12-19T23:56:54","date_gmt":"2009-12-20T04:56:54","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=1894"},"modified":"2009-12-20T13:05:01","modified_gmt":"2009-12-20T18:05:01","slug":"tularemia-rabbit-fever","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2009\/12\/tularemia-rabbit-fever\/","title":{"rendered":"Tularemia (Rabbit Fever)"},"content":{"rendered":"

Pathophysiology<\/strong><\/p>\n

1)<\/strong> cause is infection with Francisella tularensis<\/em> 2)<\/strong> occurs in more serious type A and less serious type B variants 3)<\/strong> specific clinical forms – ulceroglandular, oculoglandular, oropharyngeal, typhoidal, and pulmonary<\/p>\n

Signs and Symptoms<\/strong><\/p>\n

1)<\/strong> symptoms occur 2-5 days after introduction of organism into a human Ulceroglandular form<\/em> – 2)<\/strong> first sign is tender papule with characteristic pustular ulcer with a black base that progresses to regional adenitis in 2-3 days 3)<\/strong> followed by abrupt onset of flu-like illness (fever, chills, drenching sweats, headache, myalgias) Oculoglandular form<\/em> – 4)<\/strong> keratitis 5)<\/strong> uveitis 6)<\/strong> conjunctivitis 7)<\/strong> preauricular lymphadenopathy Oropharyngeal form<\/em> – 8)<\/strong> pharyngitis 9)<\/strong> cervical lymphadenopathy Typhoidal form<\/em> – 10)<\/strong> abdominal pain 11)<\/strong> vomiting 12)<\/strong> diarrhea 13)<\/strong> gastrointestinal bleeding Pulmonary form<\/em> – 14)<\/strong> pneumonia 15)<\/strong> nonproductive cough<\/p>\n

Characteristic Test Findings<\/strong><\/p>\n

Chest radiograph<\/em> – 1)<\/strong> bilateral patchy infiltrates\/lobar infiltrate Laboratory<\/em> – 2)<\/strong> leuckocytosis\/left shift 3)<\/strong> diagnosis is via serology: considered positive if any single titer is > 1:160 (30% specificity)<\/p>\n

Histology\/Gross Pathology<\/strong><\/p>\n

1)<\/strong> small, gram-negative, non-motile, aerobic bacillus 2)<\/strong> enlarged mesenteric lymph nodes 3)<\/strong> areas of focal necrosis in liver, spleen, lymph nodes, and skin<\/p>\n

Associated Conditions<\/strong><\/p>\n

1)<\/strong> Parinaud’s oculoglandular syndrome 2)<\/strong> hepatitis 3)<\/strong> pericarditis 4)<\/strong> meningitis 5)<\/strong> peritonitis 6)<\/strong> osteomyelitis<\/p>\n

Inheritance\/Epidemiology<\/strong><\/p>\n

1)<\/strong> type A is found in rabbits and rodents and type B is found in aquatic animals 2)<\/strong> enters humans via inhalation, ingestion, inoculation, or contamination 3)<\/strong> most cases involved with skinning wild rabbits or via tick or tabanid fly bites 4)<\/strong> endemic in southeastern USA 5)<\/strong> mortality is 5-6% in untreated cases and virtually non-existent in treated cases 6)<\/strong> does not have human-to-human transmission but is highly infectious; workers in microbiology labs who handle the organism are at risk of infection 7)<\/strong> one attack usually confers immunity<\/p>\n

Treatment<\/strong><\/p>\n

1)<\/strong> drug of choice is streptomycin IM every 12 h for 7-14 days 2)<\/strong> also effective is gentamicin used in combination with a third-generation cephalosporin 3)<\/strong> vaccination with live attenuated strains is possible.<\/p>\n

Tips for USMLE<\/strong><\/p>\n

if a 34 year old man in Georgia was out hunting and pulled some ticks out of his right leg and 4 days later had a fever and chills, and then noticed swelling in his right groin and a sore with a black scab at the base on his right anterior thigh, think tularemia<\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology 1) cause is infection with Francisella tularensis 2) occurs in more serious type A and less serious type B variants 3) specific clinical forms – ulceroglandular, oculoglandular, oropharyngeal, typhoidal, and pulmonary Signs and Symptoms 1) symptoms occur 2-5 days after introduction of organism into a human Ulceroglandular form – 2) first sign is tender […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63],"tags":[451,454,450,452,453],"yoast_head":"\nTularemia (Rabbit Fever) - 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