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Tularemia “Rabbit Fever” Francisella tularensis Michelle Lawrence Elizabeth Stolarczuk What is Tularemia? One of the most infectious pathogenic bacteria known Divided into two subcategories, type A (virulent) and type B (avirulent) Mortality rate as high as 30-60% without antibiotic treatment; with, 2% Sores, fever, aches, chills, weight loss, general incapacitation The Organism Small, nonmotile, aerobic, gram-negative coccobacillus Thin lipopolysaccharide-containing envelope Hardy, non-spore forming, survives for weeks at low temperatures in water, moist soil, hay, straw, decaying animal caracasses Type A common in North America Type B common in Europe and Asia, thought to be causative agent of all human cases History First discovered as a plaguelike disease of rodents in 1911 Studied in Japan between 1932 and 1945, and also for military purposes in the West WHO 1969 study on F. tularensis’s serious ability as a biological weapon Largest recorded airborne tularemia outbreak in 1966-67 in Sweden Infection/Disease Can infect humans through the skin, mucous membranes, gastrointestinal tract, lungs Major target organs are lymph nodes, lungs, spleen, liver, kidney Symptoms vary with virulence of organism, dose, and inoculation site Viability in Biological Weaponry The Working Group on Civilian Biodefense concludes that a weapon using airborne tularemia would likely result 3 to 5 days later in an outbreak of acute, undifferentiated febrile illness with incipient pneumonia, pleuritis, and hilar lymphadenopathy. I know of no other infection of animals communicable to man that can be acquired from sources so numerous and so diverse. In short, one can but feel that the status of tularemia, both as a disease of nature and of man, is one of potentiality. – R.R. Parker Making Tularemia a Weapon An aerosol release would have the worst medical and public consequences Not spread from person to person Slower progression of illness and lower case-fatality rate than inhalational plague or anthrax Costs to society of $5.4 billion per every 100,000 exposed persons Treatment and Precautions Mass casualty situation, oral doxycycline and ciprofloxacin are treatments of choice, and are contained in national stockpile Vaccination developed, live and attenuated, used to protect laboratorians, effective against the bacterium after 2 weeks No simple, rapid, reliable diagnostic tests in case of mass exposure available Sources Tularemia. Center for Civilian Biodefense Strategies, Johns Hopkins University. 24 October 2002. http://www.hopkinsbiodefense.org/pages/agents/agenttularemia.html Dennis, David T, MD, MPH. Tularemia as a Biological Weapon. The Journal of the American Medical Association. 24 October 2002. http://jama.amaassn.org/issues/v285n21/ffull/jst10001.html