Tularemia is a bacterial disease caused by Francisella tularensis. It occurs primarily in North America and Eurasia. Spread does not occur from human to human. The disease is contracted by contact with infected animals, eating infected meat, and from arthropod bites. During WWII, the Japanese infected prisoners of war with the organism for research purposes and after the war, the Soviet Union, Canada, Great Britain, and the United States incorporated it into battlefield weapons.
Symptoms begin with headache, muscle aches, chills, sore throat, nasal congestion, and fever. Without treatment symptoms may last for months and can progress to sepsis, bronchopneumonia, and meningitis. The antibiotic of choice for treatment is streptomycin, but gentamicin, tetracycline, doxycycline, ciprofloxacin, and chloramphenicol may also be effective. A live vaccine is under investigation at the US Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland, but the FDA has not approved it.
A bioterrorist attack with tularemia would most likely come as an aerosol. Patients would present to the ER three to five days after exposure with fever and pleuropneumonitis.
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