Consensus statement ularemia, a bacterial zoono



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Ibrahim 8A(Tularaemia as Biological weapon)

Figure 1. Cervical Lymphadenitis in a Patient With Pharyngeal Tularemia

Patient has marked swelling and fluctuant suppura- tion of several anterior cervical nodes. Infection was acquired by ingestion of contaminated food or wa- ter. Source: World Health Organization.

MANAGEMENT OF TULAREMIA AS A BIOLOGICAL WEAPON

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©2001 American Medical Association. All rights reserved.

(Reprinted) JAMA, June 6, 2001—Vol 285, No. 21 2767

tions of systemic illness. Inhalational exposures, however, commonly result in an initial clinical picture of systemic illness without prominent signs of res- piratory disease.7,43,53,56 The earliest pulmonary radiographic findings of inhalational tularemia may be peri- bronchial infiltrates, typically advanc- ing to bronchopneumonia in 1 or

more lobes, and often accompanied by pleural effusions and hilar lymphade- nopathy (FIGURE 2).72,75 Signs may, however, be minimal or absent, and some patients will show only 1 or sev- eral small, discrete pulmonary infil- trates or scattered granulomatous lesions of lung parenchyma or pleura. Although volunteers challenged with aerosols of virulent F tularensis (type A) regularly developed systemic symp- toms of acute illness 3 to 5 days fol- lowing exposure, only 25% to 50% of participants had radiological evidence of pneumonia in the early stages of infection.7,26 On the other hand, pul- monary infection can sometimes rap- idly progress to severe pneumonia, respiratory failure, and death.72,80 Lung abscesses occur infrequently.75



Typhoidal tularemia is used to de-

scribe systemic illness in the absence of signs indicating either site of inocu- lation or anatomic localization of in- fection. This should be differentiated from inhalational tularemia with pleu- ropneumonic disease.54,75

Tularemia sepsis is potentially se-

vere and fatal. As in typhoidal tulare- mia, nonspecific findings of fever, ab- dominal pain, diarrhea, and vomiting may be prominent early in the course of illness. The patient typically ap- pears toxic and may develop confu- sion and coma. Unless treated promptly, septic shock and other complications of systemic inflammatory response syn- drome may ensue, including dissemi- nated intravascular coagulation and bleeding, acute respiratory distress syn-

drome, and organ failure.80




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