i. 50-70% lipid concentrationa. Weakly staining Gram negative coccobacilli (.2-.7µm)b. Non-motilec. Contains thick capsule
a. Oligate aerobeb. Requires cysteine and iron for growthc. Infection overview:
a. Infection through tick and deer fly bites
b. Skin contact with infected animals (usually rabbits)c. Ingestion of contaminated waterd. Inhalation of contaminated aerosols or agricultural dusts
i. This form results from eating or drinking contaminated food or water. Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.d. Oropharyngeal
a. Growth of F. tularensis in culture is the definitive means of confirming the diagnosis of tularemia. Appropriate specimens include swabs or scrapings of skin lesions, lymph node aspirates or biopsies, pharyngeal swabs, sputum specimens, or gastric aspirates, depending on the form of illness.b. A presumptive diagnosis of tularemia may be made through testing of specimens using direct fluorescent antibody, immunohistochemical staining, or PCR.c. The diagnosis of tularemia can also be established serologically by demonstrating a 4-fold change in specific antibody titers between acute and convalescent sera. Convalescent sera are best drawn at least 4 weeks after illness onset; hence this method may be useful for confirming the diagnosis but not for clinical management.
a. Streptomycin is the drug of choice based on experience, efficacy and FDA approval.b. Gentamicin is considered an acceptable alternative, but some series have reported a lower primary success rate. Treatment with aminoglycosides should be continued for 10 days.c. Tetracyclines may be a suitable alternative to aminoglycosides for patients who are less severely ill. Tetracyclines are static agents and should be given for at least 14 days to avoid relapse.d. Ciprofloxacin and other fluoroquinolones are not FDA-approved for treatment of tularemia but have shown good efficacy in vitro, in animals, and in humans.
a. Great for basic info on disease
a. Detailed presentation about F. tularensis