Tularemia--What's the Risk?--And School's Out!

School's Out!

I just forgot to remind you.  ;)

Just like last year, I've decided to take the summer off from writing new posts.  I need time in the garden and for selling my books at farmers markets here and in Utah.  But last summer, I couldn't keep from writing and simply built up a nice reserve of articles to carry me through the year.  These past couple of weeks, I've been trying to compose new articles--there is still so much to learn--but without much success.  Perhaps because the garden calls.  Perhaps because I feel the need to compile the medical articles into a 2nd edition of Bring Your Own Bandages.  

Of course, I will continue to re-post previous articles.  We all need to be reminded.  I'll continue to check the comments and try to respond within a day.  Or so.  It is summer, after all.

Enjoy time outdoors and with family, and keep on preparing.

 

Since at least fifth or sixth grade, maybe even earlier, I've been fascinated with infectious disease.  Yes, my family finds it creepy.  I don't know.  Am I the only one who thinks discussing smallpox or the Spanish flu or yellow fever makes for great dinnertime conversation?

But even with my interest in these dread diseases, I couldn't remember much about tularemia or even whether it was all that serious, only that it was associated with rabbits.  Ha!  At least I remembered that correctly.  Tularemia is indeed a bacterial disease associated with rodents, rabbits, and hares.  It is usually a rural disease and occurs throughout the United States, except Hawaii, though most cases occur in the south central and western states.  The mortality rate without treatment is 33%; with treatment it is less than 2%.

As with any disease, prevention is always the best way to go.  To prevent tularemia, take the following measures, only one of which is unique to this disease:

• Use insect repellent.  Most cases of tularemia are transmitted by tick and deer fly bites.  Use DEET or something similar on the skin and permethrin on clothes.
• Wash hands often when handling sick animals or carcasses, especially rabbits and hares.
• Cook food thoroughly and make sure your water is pure.  
• Note any changes in pet rabbits, rodents, and hares.  

Tularemia is unique in that the bacteria responsible for the disease can be transmitted in numerous ways.  Diagnosis is made much more difficult because the signs and symptoms vary depending on how the person was infected and where the bacteria choose to set up housekeeping.  As noted earlier, the signs and symptoms of tularemia will depend on how the person was infected.  The incubation period is generally 3 to 5 days, but may range from 1 to 14 days. Tularemia manifests in the following forms:

• Ulceroglandular:  75% of tularemia cases are ulceroglandular and result from a tick or deer fly bite or the handling of infected animals or carcasses.  There is a single lesion at the bite site with a central eschar.  The lesion looks like other bug bites--swollen and raised, and the eschar is the actual site of the bite with the dead tissue and scab spreading out.  There is prominent lymphadenopathy (swollen glands).  The first cases identified in the United States were in Utah, and the disease, Francisella tularensis, is named for the Utah man who first researched it, Edward Francis.
• Glandular:  This is the most common form in children.  There is regional lymphadenopathy.  The glands are swollen and painful and may need draining.  The bite may have healed over or may have been overlooked.
• Oropharyngeal:  This form presents with a fever, severe sore throat, mouth ulcers, exudative pharyngitis, and tonsillitis.  It arises from ingesting contaminated food or water.  There is prominent lymphadenopathy around the neck, ears, and jaws.
• Oculoglandular:  This form is marked by eye pain, including photophobia, excessive tearing, conjunctivitis, and small ulcers of the cornea.  It may result from airborne bacteria, a splash of contaminated water, or rubbing the eyes with contaminated hands.  There is prominent lymphadenopathy around the neck, ears, and jaws.
• Intestinal:  A rare form of tularemia marked by intestinal pain, vomiting, and diarrhea.  It arises due to eating undercooked, contaminated food or drinking contaminated water.
• Pneumonic, or pulmonary:  This form occurs due to inhalation or spread from ulceroglandular or typhoidal forms.  Farmers, sheep shearers, landscapers, and lab workers are at greater risk for this form of the disease.  Symptoms are very similar to pneumonic plague and influenza, including chest pain, dry cough, and shortness of breath.  Untreated, this form has a 30-60% mortality rate.
• Typhoidal:  This form is difficult to diagnose.  There is little if any lymphadenopathy.  Symptoms are not specific and may include a high fever, nausea, vomiting, diarrhea, abdominal pain, cough, pneumonia.

Tularemia is unique in that there are so many ways it can be transmitted and so many forms it can take.  Fortunately, there is no documented transmission from person to person, so the patient does not need to be isolated.  However, and this may be significant to those with dogs, our pets can transmit it to us.  In a collapse scenario, our dogs may decide to start supplementing their diets with rabbits and hares.  And sick rabbits are easier to catch.  The dogs may contract tularemia and pass it to us.

What's interesting about tularemia is that it is classified as a Category A bioweapon by the CDC.  It's right up there with anthrax, smallpox, plague, and botulism.  It is easily disseminated, and very few bacteria are needed to cause illness. 

Fortunately, tularemia can be treated.  The drugs of choice are gentamicin or streptomycin, which are both intramuscularly or intravenously administered, and neither of which is commonly available to or stocked by preppers.   The other options are doxycycline or ciprofloxacin.  Physicians generally prescribe doxycycline 100 mg or ciprofloxacin 500 mg, both every 12 hours for 10-14 days.  Unfortunately, there's a good chance for relapse with both of these drugs.

Links to related posts:
TEOTWAWKI Tick Prevention  

For further reading:
https://emergency.cdc.gov/agent/tularemia/facts.asp
https://texashelp.tamu.edu/wp-content/uploads/2016/02/Tularemia-and-Bioterrorism.pdf
https://www.wikem.org/wiki/Tularemia--different clinical features of tularemia
https://azdhs.gov/documents/preparedness/emergency-preparedness/zebra-manual/zm-s4-tularemia.pdf
https://texasprepares.org/factsheets/factsheet_tularemia_and_bioterror_eng.pdf
https://www.ok.gov/health2/documents/Tularemia.pdf
http://outbreaknewstoday.com/isis-and-bioterrorism-tularemia-planned-use-in-turkeys-water-67823/
https://www.acsh.org/news/2017/08/24/dog-gives-woman-fatal-tularemia-potential-bioterrorism-agent-11741
https://academic.oup.com/cid/article/47/1/e4/378987
https://www.oregon.gov/oha/ph/DiseasesConditions/CommunicableDisease/ReportingCommunicableDisease/ReportingGuidelines/Documents/tularemia.pdf
https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/tularemia

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23 june 2021