Tularemia- Symptoms, Causes, Complications, And Treatment

Typically caused by bacteria called Francisella tularensis, it is one of the rarest human diseases. Tularemia is also called deer fly fever or rabbit fever, as it mostly affects animals like hares, rabbits, and rodents, such as squirrels and muskrats.

It can also infect animal species like sheep and companion animals, such as dogs, hamsters, and cats.

The bacteria infect the same area as they incubate. Tularemia enters your body through the eyes, skin, lungs, and mouth. The symptoms and their severity depend on the affected area.

Even though the disease is contagious, not a single has been reported that shows it's widespread through human-to-human contact. Some of the ways are:

1. Drinking polluted water:

   Contaminated Water can be a source of bacterial contact with infected animal species. Humans who drink or use contaminated water for personal use like drinking, cooking, bathing, or other personal uses, have been infected with oropharyngeal tularemia.

2. Inhaling contaminated aerosols:

   Humans who acquired tularemia by inhaling bacterial dust or aerosols contaminated with F. tularensis bacteria can develop an illness like pneumonia.

3. Contaminated agricultural and landscaping dust:

   Can be contaminated through infected water or animals that live near farming or landscaping activities areas. Especially when farm machinery like tractors or mowers runs over infected animals or carcasses and spreads the bacteria in the dust of agricultural areas.

4. Infected tick and deer fly bites:

   Ticks like a wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum), can transmit the bacteria from one living organism to another. Mostly the disease spread through dog ticks (Dermacentor variabilis).

   These ticks are found in areas like forest or places which are wood oriented. Also, pets like dogs, cats, rabbits, or any other animal can invite the infected tick or bacteria at home.

   Chrysops spp. Or deer flies are carriers of tularemia in the western United States. Both tick bites and deer fly bite can lead to glandular tularemia, ulceroglandular or oculoglandular tularemia.

   The source of these flies can be hunting places or while skinning or consuming infected muskrats, rabbits, prairie dogs, and other animals.

The Francisella tularensis develops an infection in the skin, eyes, lungs, and lymph nodes. Tularemia can be fatal and even life-threatening, it depends on how an individual gets infected by the bacteria. Even though it's life-threatening, the disease can be treated with a mix of different antibiotics.

The incubation period of the Francisella tularensis can be from three to five days and can go up to 21 days. Depending upon the area of infection, one can self-diagnose the type of tularemia.

Several types of tularemia can affect an individual’s body. The diagnosis of the type depends on the affected area or the organ. There are four types of tularemia and each type of tularemia has its own set of symptoms.

1. Ulceroglandular tularemia:

   This is one of the most common tumors of all four. It usually comes from an infected tick or deer fly bite. A skin ulcer appears at the bite site from where the bacteria have entered the body.

   The ulcer also shows signs of swelled regional lymph glands, usually the armpit or groin. Common symptoms like fever, headaches, fatigue, and chills

2. Glandular tularemia:

   It is quite identical to the ulceroglandular tularemia but without an ulcer on the site of infection. Also, people generally acquired it through the same source of infection like the bite of an infected tick or deer fly.

3. Oculoglandular tularemia:

   When the tularemia enters its way in your body through your eye. When a person handles an infected animal and touches their eyes with unclean and infected hands. Symptoms often include inflammation, irritation, and itchiness in the eye.

   The eyes of the infected person appear to be red, with unusual discharge or even an ulcer under the skin of the inner eye. This may lead to light sensitivity or even swelling in the front of the lymph glands of the ear.

4. Oropharyngeal tularemia:

   This develops from consuming or working with contaminated food or water. Patients with oropharyngeal tularemia can spread to your digestive tract from mouth and throat which can lead to other symptoms like:

   • Fever
   • Mouth ulcers
   • Vomiting
   • Inflamed tonsils
   • Abdominal pain
   • Diarrhea
   • Throat pain
5. Pneumonic tularemia:

   This type of tularemia illness can have signs and symptoms identical to pneumonia. Symptoms like dry cough, chest pain, and difficulty breathing can be seen when a person is infected in the lungs with pneumonia tularemia.

6. Typhoidal tularemia

   This type of illness can be characterized by a combination of general symptoms. Common symptoms like:

   • High fever and chills
   • Enlarged spleen
   • Muscle pain
   • Sore throat
   • Vomiting and diarrhea
   • Pneumonia
   • Enlarged liver

It is advisable to seek medical attention if you think you might have been exposed to the bacteria or see symptoms within three to five days. It will be easy to diagnose in the case of the tick bite, fly deer bite, or if you have consumed or handled an infected animal. Also in the mild case of skin ulcer or swollen lymph nodes.

Even though the signs are quite confirmatory, the medical diagnosis will result in fast recovery and treatment. Most of the recommended diagnoses to examine F. tularensis infection are listed below. Your medical expert will suspect tularemia sends the samples in the laboratory for special diagnostic and safety procedures.

• The first diagnosis will include swabs, touch or scrapings of ulcers, biopsies of swollen lymph nodes, pharyngeal swabs, and respiratory specimens, which depends on the form of illness the patient poses. Blood tests in case of tularemia can be inaccurate as the disease is mostly inherited on the surface of the infected area and the nature of the bacteria, which is quite slow-growing.
• The secondary medical diagnosis is seroconversion. From negative to positive IgM and IgG antibodies can be found in the paired sera. Usually, the serum sample is taken in two parts, the first one would be collected during the initial phase of the disease that is within the first week of infection signs. The second serum sample should be gathered within 2-3 weeks of the collection of the first sample.
• The tertiary Detection test for F. tularensis is a specimen of the direct immunofluorescence assay (DFA), polymerase chain reaction (PCR) assay, or immunohistochemical staining of the patient. This will help the doctor to identify the cause of the disease.

Note:Tularemia is one of the rarest human diseases, so if one of the tests came positive, it does not mean the whole set of diagnoses will reflect the same. Healthcare professionals believe that all three types of diagnoses should be conducted to conclude the final result.

Even though a general medical practitioner is qualified to diagnose and treat infectious diseases, one must seek an Infectiologist for severe illnesses like tularemia.

Infectiology is a field of study usually focused on the diagnosis and treatment of infectious diseases. A healthcare specialist that educates or practices the field of infections can be referred to as an Infectiologist.

Treatment of tularemia can be vigorous, as there is no specific vaccine has been discovered yet. So to lower down the bacterial infection and its symptoms the doctor will prescribe you the set of medications.

But before that, one may collect information related to the patient’s medical history, age, pregnancy status, underlying health conditions, or allergies. Consult an Infectiologist regarding a patient's treatment for tularemia infection.

Here is the combination of antibiotics that your doctor may prescribe to cure the surface symptoms and roots of the illness:

1. Streptomycin:

   The medication is used to treat general bacterial infections which include TB (tuberculosis), endocarditis, brucellosis, Mycobacterium avium complex, Burkholderia infection, tularemia, plague, and rat-bite fever. It is suitable for both adults and children but in an advisable quantity.

2. Gentamicin:

   It is usually sold under the name of Garamycin, the Gentamicin antibiotic used to treat various bacterial infections which may include bone infections, endocarditis, meningitis, urinary tract infections, pelvic inflammatory disease, pneumonia, and sepsis among others. Garamycin is suitable for both adults and children but in a prescribed quantity.

3. Ciprofloxacin:

   Or Cipro is known as a broad-spectrum antibiotic. Which means it works against different types of bacterial infection. It is a strong medication and mostly used to treat serious infections which cannot be treated by any other antibiotics.

   Ciprofloxacin is used to treat bacterial infections which species occur in the chest including pneumonia. The medication is rarely used to treat children infected with tularemia, as it can be harmful to their fragile immune systems.

4. Doxycycline:

   It is known as one of the strongest antibiotic drugs in the world. Doxycycline kills a wide and newly discovered bug infection that is usually difficult to get cured with other antibiotics. These may include bacteria and parasites that are known as intracellular organisms.

   An intracellular organism is a type of bacteria, virus, or pathogen that makes a host inside of a living orgasm blood cell. The condition is difficult to be treated by any other antibiotic and the medication is not suitable for children except critical conditions.

Since there is no vaccine available to cure tularemia. It is crucial to prevent oneself from bacterial infection. If your work profile requires working in an area with a high-risk presence of tularemia. these precautions and prevention measures will help you to lessen your chance of getting infected:

• Protection from bugs and insects:

  Tularemia is often spread through a tick bite or deer fly bite or mosquito bites. So it is advisable to wear long-sleeved shirts and long pants with socks, and a broad-brimmed hat before going in an insect-prone area. This will help you to protect your face, neck, and ankles where these insects bite the most.

• Insect Repellent:

  Also, apply insect repellent with 20% to 30% DEET, picaridin, or IR3535 to be extra protected. Check yourself and your pets for ticks or any fly bites. Remove any tick immediately from you or your pet’s body if you find any.

  Note:follow the manufacture's directions carefully for any allergic or non suitable compound before using.

• Take gardening precautions seriously:

  Mostly Home gardeners and professional landscapers are susceptible to get exposed to the bacteria. Preventions like wearing a face mask, gloves, and checking oneself for any bite will help an individual to be protected.

• Handle animals carefully:

  Animals like wild rabbits or hares can be a potential carrier of the disease, wear protective gloves and goggles before and wash your hands thoroughly after touching the animal.

• Cook all types of wild meat:

  thoroughly, undercooked meat of an infected animal may cause bacterial illness. Studies have shown that high temperature can kill F. tularensis, so cooking meat at a minimum temperature of 160 F (71.1 C) for ground meat and game meat and Poultry products 165 F (73.8 C) is recommended to sterilize.