[Ixodid ticks of Pavlodar Province and their participation in the circulation of tularemia infection]

Investigations carried out in Pavlodar Province have shown that 7 species of ixodid ticks, Ixodes crenulatus, I. lividus, I. persulcatus, I. laguri laguri, Dermacentor marginatus, D. reticulatus, Haemaphysalis concinna, and one brought species, Hyalomma asiaticum, parasitize domestic animals and wild mammals. Maximum activity of pasture ticks of the genus Dermacentor falls on the end of April--beginning of May, that of H. concinna on the beginning of June. The growth in the abundance of pasture ticks, recorded during the last years, is favoured by the increase in the cattle live stock, its seasonal movements and pasture area reduction. Natural nidi of tularemia become more active. Since 1977 221 cultures of tularemia agent have been isolatid from pasture ticks. H. concinna takes the most active part in the infection circulation.

[A case of erythema nodosum in tularemia]

Since 1980 some epidemics of tularemia occurred, involving large areas of Tuscany (Italy). Among the different clinical features described in the classic form of tularemia, erythema nodosum never has been reported. One case of erythema nodosum, the first reported in course of tularemia, is described. The correct diagnosis is based on careful question about exposure to mammals and ticks. The importance of early treatment is stressed.

A waterborne tularemia outbreak

A waterborne tularemia outbreak is described. Forty nine cases were identified in Sansepolcro, a small Medioeval town in the province of Arezzo, Tuscany, Italy. All cases had laterocervical or sub-mandibular adenitis, and occurred within a period of three weeks during March and April 1982. The study showed association between cases and the consumption of water from an unchlorinated water system. Francisella tularensis type 1 was isolated from wild hares captured in the area.

Bronchial changes in airborne tularemia

We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term 'typhoidal' tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.

Tularemia in otolaryngologic practice. An analysis of 127 cases

Ulceroglandular, glandular, and oropharyngeal forms of tularemia may occur in otolaryngologic patients, frequently causing diagnostic difficulties. A retrospective analysis of 127 patients with serologically proved tularemia in the head and neck region is presented with special reference to diagnostic difficulties. Short case reports of six patients are included. Difficulties seemed to appear especially in the diagnosis of glandular tularemia. Oropharyngeal tularemia is easily confused with infectious mononucleosis. A high degree of suspicion of tularemia is recommended in endemic areas.

Tularemia in adults and children: a changing presentation

Tularemia, a febrile zoonosis with six clinical types, recently has been shown to occur at an increased incidence in children compared with previous reports. Ulceroglandular and glandular tularemia are still the most common types, but pneumonic tularemia has increased in incidence. However, with these changes, an overall decline in mortality has been observed. Children exhibit fever, pharyngitis, hepatosplenomegaly, and constitutional symptoms more often than affected adults. The complication of late lymph node suppuration is found in half of the tularemia patients with lymphadenopathy. A high index of clinical suspicion and a good medical history and physical examination confirmed by specific serologic studies are the critical factors in the successful diagnosis of tularemia in children.

A family outbreak of tularemia

A family cluster of tularemia is described. In a family of three members different clinical type of the disease occurred after having been exposed to a sick wild hare. From the hare kidney Francisella tularensis type 1 was isolated. Pneumonic, typhoid-like tularemia occurred in the father who inhaled hare skin hairs and an ulceroglandular form in the mother and in the child who had direct contact with the animal.

Tularemia: emergency department presentation of an infrequently recognized disease

Tularemia is an uncommon, highly communicable disease occurring with seasonal regularity in endemic parts of the United States. The varied signs and symptoms may confound the unwary physician. Two cases are reported illustrating the ulceroglandular and ingestion forms of the disease. Septic (typhoidal), oculoglandular, pleuropulmonary, glandular, and oropharyngeal forms also are described. Knowledge of the epidemiology and a high index of suspicion should lead the examining physician to ask revealing questions. The diagnosis is presumed upon clinical grounds and confirmed by serological testing. According to published reports delayed diagnosis can result in an overall mortality rate of 7% of cases; however, early diagnosis will lead to uncomplicated recovery in most cases.

[Rise in the epizootic activity of a natural focus of steppe-type tularemia in Stavropol Territory and its epidemic consequences]

One of recurrent autumn and winter rises in the epizootic activity of the steppe-type focus of tularemia in the Stavropol Territory is described. During the tularemia epizooty of 1981-1982 the population of common voles (Microtus arvalis) was very numerous, while the population of house mice (Mus musculus) was comparatively scarce. Francisella tularensis strains were isolated from different species of rodents (Microtus arvalis, Mus musculus, Apodemus sylvanicus, Rattus norvegicus, Lepus, etc.), from fleas and ticks, as well as from environmental objects (well-water, hay). 38 cases of the disease among nonvaccinated persons, mainly in rural areas, were registered. Anginous-bubonic tularemia was the dominant form of the disease. A complex of measures aimed at the detection of tularemia and its liquidation among the population was carried out.

Airborne transmission of tularemia in farmers

In a tularemia epidemic during 1982 in northern Finland, 53 patients showed no peripheral portal of entry for infection or associated lymphadenopathy. Respiratory symptoms were observed in 72% of the patients. 26/38 cases had abnormal chest films. Hilar adenopathy was the most common finding (36%). Four patients did not receive antibiotics; 43 received tetracyclines, 5 streptomycin and 1 cefuroxime and amoxycillin. All patients recovered. 50 patients acquired the infection during common farming activities, such as making fresh hay with a hay-cutter, handling dry hay, threshing, etc. Thus, airborne transmission may be an important source of infection in normal farming activities in endemic areas of tularemia.

[2 cases of tularemia observed at Monte Amiata]

Two cases of tularemia caused by direct contact with an infected hare are described. Recent epidemiological discoveries about the disease are reported with reference to other known foci in Tuscany and the measures taken to control and isolate the infected areas.

Infections acquired in the fields and forests of the United States

Sportsmen, backpackers, and outdoor workers may present with unusual infections acquired in the fields and forests of the United States. Infections to be considered in such persons with a febrile illness include Rocky Mountain spotted fever, Colorado spotted tick fever, babesiosis, borreliosis, and Lyme disease. The differential diagnoses for clinical presentations of pulmonary and gastrointestinal disease are also discussed.

[Antibody dynamics of carnivorous mammals and corvine birds infected with Francisella tularensis]

The time course of antibody formation in carnivorous mammals and corvine birds infected with a single injection of F. tularensis has been experimentally studied in the agglutination test and the passive hemagglutination test. In carnivorous mammals the allergic transformation of the body has been established by means of the leukocytolysis test.

An outbreak of tularemia in the northern part of central Sweden

An extensive epidemic of tularemia with 529 cases, 400 of which were confirmed by laboratory tests, occurred in the northern part of central Sweden during the summer of 1981. The outbreak was of short duration and was restricted to certain communities within a narrow geographical area. It began in the middle of July and progressed during that month and August, with only sporadic cases in September and October. During the 2 years preceding the outbreak only 3 and 7 cases were reported in Sweden. The infection was mainly transmitted by mosquitoes and most cases were ulceroglandular. The later cases in September and October were infected by contact with hares or rodents. All age groups were affected, with a slight predominance of women and the 30-60 yr age groups.

Tularaemia transmitted by ticks (Dermacentor andersoni) in Saskatchewan

Common wood ticks (Dermacentor andersoni) collected from Saskatchewan Landing Provincial Park, Saskatchewan in the spring of 1982 transmitted a lethal tularaemia infection to four of six rabbits. Francisella tularensis organisms were isolated from tissues taken from the dead rabbits and identified from subcultures using an indirect immunofluorescent antibody assay. One human associated with the animals developed symptoms of tularaemia and, after successful therapy, had a significant increase in titre of specific antibodies to F. tularensis. This is the first time tick-transmitted tularaemia has been reported in Saskatchewan in more than 25 years.

Clinically mild tularemia associated with tick-borne Francisella tularensis

Between May 9 and July 3, 1979, 12 cases of glandular or ulceroglandular tularemia occurred in residents of the Crow Indian Reservation in southcentral Montana; only 13 cases had been reported from this geographic area in the preceding 25 years. The illness was mild, characterized by fever and cervical or occipital adenopathy. Systemic symptoms were self-limited although residual lymphadenopathy was common. Francisella tularensis was isolated from ticks (Dermacentor variabilis), the suspected vector. The strains of F tularensis did not ferment glycerol and thus were identified as type B rather than the more virulent type A. None of 83 adults hospitalized in an urban area 50 miles from the reservation had agglutination titers of antibody to F tularensis of greater than or equal to 1:40 compared with eight of 77 patients at the reservation hospital (P less than 0.01). Mild tularemia in reservation residents may have gone unrecognized; similar illness due to type B F tularensis may occur elsewhere.

Quantum differences in oral susceptibility of voles, Microtus pennsylvanicus, to virulent Francisella tularensis type B, in drinking water: implications to epidemiology

Shedding nephritis in voles with chronic tularemia is the probable source of frequent contamination of streams over wide areas of the northern hemisphere. However, voles inoculated parenterally with as few as one dex viable cells of Francisella tularensis palaearctica succumb uniformly to acute tularemia, whereas voles, beavers, and muskrats often thrive in waters contaminated with the organism. Nevertheless, water-borne epizootics do occur in these animals, and at these times streams are heavily contaminated. In attempts to determine the lethal dose, per os, of the bacteria to voles, it was found that there are stable, 'order-of-magnitude' differences in susceptibility of individual weaned voles reared under uniform conditions. Also, voles thus infected often became chronically infected with bacteriuria. It is proposed that the most susceptible voles are responsible for amplification of water contamination and thus for initiation of water-borne epizootics in hygrocolic mammals and for frequent mild infections in man.

Oropharyngeal tularemia

A case of oropharyngeal tularemia mimicking a peritonsillar abscess is presented. This diagnosis should be entertained in patients who are seen initially with ulcerative-exudative pharyngitis with or without tonsillitis and whose routine cultures are negative and/or are unresponsive to penicillin. Institution of appropriate therapy depends largely on the clinical diagnosis because cultures on ordinary media are routinely negative, and it takes several days for antibody titers to reach diagnostic significance.

Fatal-cat trasmitted tularemia: demonstration of the organism in tissue

The case reported represents an unusual mode of transmission of tularemia from cat to man, with fatal outcome. The use of the modified Dieterle spirochete stain demonstrated F tularensis in tissue when all other routine stains failed. Direct immunofluorescent staining confirmed the presence of the organism in tissue sections. F tularensis and the etiologic agent of Legionnaires' disease are similar only in their ability to stain with the modified Dieterle stain and their inability to stain with conventional histochemical technics.

Tularemia pneumonia in Washington, DC. A report of three cases with possible common-source exposures

In June 1978, three cases of tularemia pneumonia occurred in persons residing in the Washington, DC, area. The patients, all men, became ill three to four days after a brief session training their hunting dogs in an undeveloped wooded area adjacent to a housing complex. One of the dogs, which later died, had captured a wild rabbit during the training session. All three men had handled the rabbit while familiarizing their dogs with the rabbit's scent. The men had no other common exposure that was a likely source of infection.