What is tularemia?
Tularemia is a disease caused by a bacterium, Francisella tularensis, which infects both animals and people. Although infection occurs among many wild and domestic animals, the rabbit is most often involved in disease outbreaks. Tularemia is relatively rare in New York City, though infections do occur. Since 2004, there have been two tularemia cases reported from Staten Island. One person became ill and was diagnosed with tularemia after a family dog killed a wild rabbit and brought the carcass home. In 2007, a Staten Island child was infected shortly after two tick bites. In 2008, a Brooklyn man was infected when camping overnight in a wetland area. A Manhattan woman was probably infected in 2009 when visiting Europe. For the most recent information on NYC residents reported with tularemia, visit EpiQuery.
What are the symptoms of tularemia?
The symptoms of tularemia depend on whether the bacteria enter through the skin, gastrointestinal tract, lungs, or eyes. Tularemia usually is recognized by the presence of a skin ulcer at the location where the bacteria entered the skin and swollen lymph nodes (glands). Swallowing the organism in food or water may produce a throat infection, abdominal pain, diarrhea, and vomiting. Inhalation of the organism may produce a pneumonia-like illness. If the organism infects the eyes, it can cause painful swelling of the lids, red eyes, and visual pain.
What are the different types of tularemia?Pneumonic tularemia (lung): If F. tularensis bacteria are inhaled into the lungs, they can cause pneumonia, a serious lung infection. Fever, headache, muscle aches and joint pain (flu-like illness) is followed by dry cough, chest pain and breathing discomfort.
Ulceroglandular tularemia (skin and lymph node): F. tularensis can enter the skin through cuts and abrasions if one handles an infected animal carcass without gloves or if an infected tick or biting fly attaches and feeds on human blood. Fever, chills, and muscle aches are usually followed by a painful skin ulcer and tender lymph nodes in the neck, armpit or groin, depending on where the bacteria entered the skin.
Glandular tularemia (lymph node): Sometimes, F. tularensis is introduced into the skin as above, but a skin ulcer is not found. Except for this detail, symptoms are the same as with ulceroglandular tularemia.
Pharyngeal tularemia (throat): When F. tularensis is swallowed in contaminated food or beverage, it can result in a serious throat infection. Typical symptoms are fever, chills, severe sore throat and enlarged and tender lymph nodes in the neck.
Oculoglandular tularemia (eye and lymph node): Painful eye infections can occur if F. tularensis bacteria are rubbed into an eye. Symptoms include fever, chills, painful yellow bumps on the surface of the eyes and the inside surface of the eyelids, pus draining from the eyes, swelling around the eyes and enlarged and tender lymph nodes in the neck and on the head.
Typhoidal tularemia (like typhoid fever): In some patients, when F. tularensis spreads through the bloodstream the illness can appear similar to another disease called typhoid fever. If not treated with antibiotics, it can be very severe and even fatal. Fever, headache, muscle aches and joint pain (flu-like illness) are followed by extreme weakness, inability to get out of bed, vomiting, diarrhea and dehydration.
How soon after infection do symptoms appear?
Symptoms can appear within 1 to 14 days, with most occuring within 3 to 5 days.
Who gets tularemia?
Hunters, hikers, or other people who spend a great deal of time outdoors and who may come in contact with wild animals and their carcasses or who may be bitten by infected ticks or biting flies are at greater risk for exposure to this organism.
How is tularemia spread?F. tularensis organisms can enter the skin or the thin tissue layers of the mouth, throat, nose and eyes if one comes into contact with an infected animal’s blood, meat or carcass, or if eating or drinking contaminated food or drink. Penetration through the skin also can occur following bites of infected ticks or biting flies. The bacteria can be inhaled if the organism becomes airborne in certain outdoor environments, such as near estuaries and coastlines. Human-to-human transmission of F. tularensis infections does not occur.
Is tularemia contagious?
No. Person-to-person transmission of tularemia does not occur.
How is tularemia diagnosed?
Tularemia can be diagnosed by culturing the bacteria from blood, sputum, or wounds; however, it can be difficult to grow. It also can be diagnosed with antibody testing.
What is the treatment for tularemia?
A number of antibiotics can be used to treat tularemia.
How can tularemia be prevented?
Rubber gloves, masks, and eye protection should be used when skinning or handling animal carcasses (especially rabbits). Wild rabbit and rodent meat should be cooked thoroughly before eating. Wells and other waters contaminated with dead animal carcasses should not be used. Insect repellents and long clothing should be used when walking through areas known to contain F. tularensis-infected deer flies and ticks. Laboratory workers need to take special precautions to avoid being exposed to this organism when working with specimens that come from patients suspected of having tularemia.
What has New York City done to address the threat of tularemia?
Many federal, State, and City agencies-including the New York City Health Department-have been working together for several years to prepare for the detection and response to a bioterrorist event in New York City. In cooperation with other emergency response agencies, the New York City Health Department has set in place systems that improve our ability to detect and respond to public health emergencies caused by the intentional release of a biological agent.
For more information about tularemia, visit the CDC's website.