Tularemia

From: Subject: Tularemia Date: Sun, 17 Nov 2002 09:13:26 +0200 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0023_01C28E19.966EDE10"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_0023_01C28E19.966EDE10 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.hopkins-biodefense.org/pages/agents/agenttularemia.html Tularemia <= /TABLE> ------=_NextPart_000_0023_01C28E19.966EDE10 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.hopkins-biodefense.org/images/head_agents.gif R0lGODlhRAJPALMAAAAAALy8vJlMAD4+PpmZmYSEhP///2ZmZubm5iEZEdmMP7CwsMxmAFJSUuKp b9bOyCH5BAQUAP8ALAAAAABEAk8AAAT/EMhJq7046827/2AojmRpnmiqrmzrvnAsf0ISCnOu73zv /8CgcEhMJRi2UKJWbDqf0Kh0Sq26BAzcCJu0er/gsHhM9mK1JAayzG673/B4+7guYevyvH7P7/s/ 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<= FONT=20 size=3D2>Anthrax =B7 Bot= ulinum=20 Toxin =B7 Pl= ague =B7 = Smallpox =B7 Tularemia =B7 VHF

Tularemia

Fact=20 Sheet Info

Francisella tularensis, the organism that causes=20 tularemia, is one of the most infectious pathogenic bacteria = known,=20 requiring inoculation or inhalation of as few as 10 = organisms to=20 cause disease. It is considered to be a dangerous potential=20 biological weapon because of its extreme infectivity, ease = of=20 dissemination, and substantial capacity to cause illness and = death.

During World War II, the potential of F. = tularensis as a=20 biological weapon, was studied by the Japanese as well as by = the US=20 and its allies.

Tularemia was one of several biological weapons that were = stockpiled by the US military in the late 1960's, all of = which were=20 destroyed by 1973. The Soviet Union continued weapons = production of=20 antibiotic and vaccine resistant strains into the early = 1990s.

Francisella tularensis is a hardy non-spore = forming=20 organism that is capable of surviving for weeks at low = temperatures=20 in water, moist soil, hay, straw or decaying animal = carcasses.

F. tularensis has been divided into two = subspecies: F.=20 tularensis biovar tularensis (type A), which is the most = common=20 biovar isolated in North America and may be highly virulent = in=20 humans and animals; F. tularensis biovar palaearctica = (type=20 B) which is relatively avirulent and thought to the cause of = all=20 human tularemia in Europe and Asia.

Tularemia is a zoonosis. Natural reservoirs include small = mammals=20 such as voles, mice, water rats, squirrels, rabbits and = hares.=20 Naturally acquired human infection occurs through a variety = of=20 mechanisms such as: bites of infected arthropods; handling=20 infectious animal tissues or fluids; direct contact or = ingestion of=20 contaminated water, food, or soil; and inhalation of = infective=20 aerosols. F. tularensis is so infective that = examining an=20 open culture plate can cause infection.

Human to human transmission has not been documented.

In the natural setting, tularemia is noted to be a = predominately=20 rural disease with clinical presentations including = ulceroglandular,=20 glandular, oculoglandular, oropharyngeal, pneumonic, = typhoidal and=20 septic forms.

The Working Group on Civilian Biodefense believes that of = the=20 various possible ways that F. tularensis could be = used as a=20 weapon, an aerosol release would cause the greatest adverse = medical=20 and public health consequences.

A World Health Organization (WHO) expert committee = reported in=20 1970 that if 50 kg of virulent F. tularensis was = dispersed as=20 an aerosol over a metropolitan area with a population of 5 = million=20 there would an estimated 250,000 incapacitating casualties,=20 including 19,000 deaths.

Aerosol dissemination of F. tularensis in a = populated area=20 would be expected to result in the abrupt onset of large = numbers of=20 cases of acute, non-specific febrile illness beginning 3 to = 5 days=20 later (incubation range, 1-14 days), with pleuropneumonitis=20 developing in a significant proportion of cases over the = ensuing=20 days and weeks. Without antibiotic treatment, the clinical = course=20 could progress to respiratory failure, shock and death.

The overall mortality rate for severe Type A strains has = been=20 5-15%, but in pulmonic or septicemic cases of tularemia = without=20 antibiotics treatment the mortality rate has been as high as = 30-60%.=20 With treatment, the most recent mortality rates in the US = have been=20 2%. Aminoglycosides, macrolides, chloramphenicol and=20 fluoroquinolones have each been with used with success in = the=20 treatment of tularemia.

In the United States, a live-attenuated vaccine derived = from the=20 avirulent Live Vaccine Strain (LVS) has been used to protect = laboratory personnel routinely working with F. = tularensis.=20 Given the short incubation period of tularemia and = incomplete=20 protection of current vaccines against inhalational = tularemia,=20 vaccination is not recommended for post-exposure = prophylaxis.

Given the lack of human-to-human transmission, isolation = is not=20 recommended for tularemia patients.

The Working Group lacks information on survival of=20 intentionally-dispersed particles, but would expect a short=20 half-life due to dessication, solar radiation, oxidation and = other=20 environmental factors, and a very limited risk from = secondary=20 dispersal.

Simple, rapid and reliable diagnostic tests that could be = used to=20 identify persons infected with F. tularensis in the = mass=20 exposure setting need to be developed. Research is also = needed to=20 develop accurate and reliable proced-ures to rapidly detect = F.=20 tularensis in environmental samples.

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Copyright =A9 2000 The Johns Hopkins = University=20 on behalf of its Center for Civilian Biodefense Studies. All = rights=20 reserved.