Tularemia

Bubonic tularemia is characterized with primary damage of spot where infection entered. This form may occur on eyes when pathogen hits conjunctiva. Typically, on conjunctiva appears yellow follicular growth of millet grain size. When bubo develops in periotic and inframaxillary areas, the disease course is more lasting.

Anginal bubonic tularemia occurs in case of primary damage of mucus membrane of one of tonsils. Patient is infected via food.

Some forms of  tularemia do damage internals. Pulmonary tularemia frequently occurs in fall and winter time. Generalized form courses like common infection with frank toxicosis, loss of consciousness, delirium, severe headaches and muscle pains.
There may be specific complications (secondary tularemic pneumonia, peritoneal inflammation, pericarditis, meningoencephalitis), and apostasis, gangrene caused by secondary bacterial flora.

Diagnosis is made on the basis of skin and serological tests.

Treatment
Admission of patient. Major treatment with antibacterial medications (tetracycline, aminoglycoside, streptomicin, laevomycetin) is performed till fifth day of normal body temperature. In long-running cases is used combination therapy with antibiotics and vaccine. It is very important to take vitamins and make recurrent donor-specific transfusions. In case of bubo fluctuation is performed surgical intervention (a wide cut to help bubo to release liquid). Patients leave hospital only after full clinic recovery.

Prevention
1. liquidation of hot spots or reduction of their areas
2. protection of houses, surface waters and food from mouse-like rodents
3. vaccination of people in hot spots of  tularemia

Tularemia

Tularemia is a zoogenous infection with natural nidality. Tularemia is characterized with intoxication, fever, lymph nodes damage. Pathogen is tiny microbe which dies at the temperature 60C in 5 – 10 minutes. Reservoirs of the rod are rabbits, water rats, field mice. The infection is transmitted to human directly via infected animals (hunting) or via infected products and water, and rarely via aspiration way (while processing grain products) or blood-sucking insects (acarian, mosquito).

Symptoms and treatment
Incubation period is from several hours to 3 – 7 days. There are three forms of tularemia: bubonic, pulmonic and generalized. The disease starts acutely with sudden temperature rise up to 38 – 40C. Appears acute headache, giddiness, pains in muscles of legs, back, lumbar region and appetite loss. In severe cases may appear vomit and nose bleed.

Specific symptoms: frank sweating, sleeping disorders such as insomnia or sleepiness. Frequently is observed euphoria and activity increase on the back of high temperature. Sometimes in the first days of the disease is observed redding and puffiness of face and conjunctiva. Then on oral mucosa appear punctate hemorrhages. Tongue has grayish fur. Most specific symptom is increase of lymph nodes and it may have various sizes.

Patient may experience brachycardia and hypotension. Liver and spleen get increased not in all cases. Pains in abdomen are possible when lymph nodes are significantly increased. Fever lasts from 6 to 30 days.

Bubonic form of Tularemia
Pathogen enters into the body via skin without leaving any trail. In 2 – 3 days develops regional lymphadenitis. Buboes are less painful and have crisp outlines with size of 5 cm. Then in 1 – 4 months occurs softening of buboes or their self-induced opening with releasing stiff creamy pus and formation of fistula. Most often are damaged lymph nodes in armpits, groin and tights.