Tularemia Case Report

Due to the increase in tularemia diagnoses over the past two decades, Michael Kelson, et al, published a case report in Cureus to raise awareness of the rare yet life-threatening zoonotic infection, which initially presents with non-specific flu-like symptoms mostly during the summer months.

 Tularemia; credit: Late Ed Masters, MD

Caused by the gram-negative bacterium Francisella tularensis, tularemia is highly contagious and needs only as few as 10 microorganisms to cause life-threatening illness. The bacteria are transmitted to humans via tick bites, direct contact with diseased animals, and by inhaling contaminated aerosols.

Tularemia, aka, “rabbit fever,” is classified as a Category A bioterrorism agent. Tularemia infections are uncommon with low, naturally occurring transmission rates in the U.S., however, the disease is highly infectious and can be fatal if left untreated. The range of non-specific symptoms exhibited by patients such as fever, malaise, chills, headache, and fatigue make diagnosis challenging and make it necessary for providers to attain a thorough exposure history.

The case report describes a 13-year-old male pediatric patient presenting with fever, ulceration, and lymphadenopathy, who ultimately received a delayed diagnosis of ulceroglandular tularemia following laboratory testing.

Once diagnosed with tularemia the patient was started on IV gentamycin and after his difficult, five-week course of tularemia infection, the fever finally resolved, and the ulcer started to dry up.  He was then able to be discharged for home care with gentamycin administered through a peripherally inserted central catheter line.

The researchers emphasize that awareness about tularemia and its presentation of non-specific systemic symptoms is critical for early detection and ensuing treatment of the bacterial infection. Because this disease is more frequent during summer months, providers should have an increased clinical suspicion during this season.

Read the case report.

Read more about tularemia.