2766 JAMA, June 6, 2001—Vol 285, No. 21 (Reprinted)
©2001 American Medical Association. All rights reserved.
ment, typical of other granulomatous conditions, such as tuberculosis and sarcoidosis.20,70,71
Monkeys that inhaled the virulent
SCHU S-4 strain of F tularensis (type A) developed acute bronchiolitis within 24 hours of exposure to 1-µm particles and within 48 hours of exposure to 8-µm par- ticles.73 By 72 hours following chal- lenge, inflammation was present in peri- bronchial tissues and alveolar septa. Bronchopneumonia was most pro- nounced in animals exposed to the smaller particles and was characterized by tracheobronchial lymph node en- largement and reddish, firm, 0.2- to 0.5- cm-diameter discrete inflammatory le- sions scattered throughout the lungs. In the absence of treatment, the disease pro- gressed to pneumonic consolidation and organization, granuloma formation, and eventual chronic interstitial fibrosis.
Humans with inhalational expo-
sures also develop hemorrhagic inflam- mation of the airways early in the course of illness, which may progress to bron- chopneumonia.54 Histopathological ex- amination of affected lungs shows al- veolar spaces filled with an exudate of mononuclear cells. Pleuritis with ad- hesions and effusion and hilar lymph- adenopathy are common radiological and pathological findings.70,72
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