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TULAREMIA, PNEUMONIC - USA: (NEW YORK CITY)
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A ProMED-mail post
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International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 11 June 2008
Source: New York City Dept of Health & Mental Hygiene (DOHMH), Bureau of
Communicable Disease [edited]
<http://home2.nyc.gov/html/doh/html/cd/cd.shtml>
The New York City DOHMH is investigating a laboratory-confirmed case of
pneumonic tularemia in a Brooklyn resident. The patient presented to the
hospital in early June 2008 with a one-week history of fever, headache,
sweats, left sided pleuritic chest pain, and shortness of breath.
Pleural fluid culture yielded small, slow-growing Gram negative bacteria
that were referred to the New York City Public Health Laboratory for
identification. The organism was confirmed as _Francisella tularensis_. The
patient reported camping in Gateway National Recreation Area in Brooklyn 4
days prior to the onset of his symptoms.
Tularemia is rare in New York City; however, cases have been reported in
all New York City boroughs except for the Bronx. Since 1965, there have
been 15 other reported cases, with the last case occurring in 2007 in a
Staten Island child. In the USA, about 100-200 cases are reported annually,
with most occurring in the south, central, and western states; the case
fatality rate is about 1.0 per cent.
Tularemia is caused by _F. tularensis_, a small, non-motile, Gram negative
intracellular coccobacillus. It can be found in a variety of animal hosts,
notably lagomorphs (rabbits and hares), aquatic rodents (muskrats, beavers,
and water voles), other rodents (water and wood rats and mice), squirrels,
and cats. A USA outbreak involving commercially distributed prairie dogs
occurred in 2002.
_F. tularensis_ can be recovered from contaminated water, soil, and
vegetation as it can persist for weeks under ideal environmental
conditions. _F. tularensis_ also can be found in amoebas (such as,
_Acanthamoeba_), which can become airborne in some settings, and may
represent a significant environmental reservoir for this bacterium.
Humans can become incidentally infected through diverse environmental
exposures: bites by infected ticks and deerflies; contact with infectious
animal tissues or fluids; direct contact with or ingestion of contaminated
food, water, or soil; and inhalation of infective aerosols. In one case,
bacteria were aerosolized from the fur of a dog as it shook itself off
after entering a home. Finally, there are several reports of tularemia in
humans following bites from infected domestic cats. It is highly
infectious, with as few as 10 organisms needed to cause disease. Humans can
develop severe and sometimes fatal illness, but do not transmit the disease
to others. The typical incubation period is 3 to 5 days, with a range of
one to 14 days.
The clinical presentation of tularemia depends on the route of exposure.
Airborne _F. tularensis_ would mainly cause pleuropneumonitis. Exposures
that penetrate broken skin result in ulceroglandular or glandular disease.
The onset of tularemia is usually abrupt, with fever, headache, chills and
rigors, generalized body aches (often prominent in the low back), coryza,
and sore throat. Nausea, vomiting, and diarrhea may occur. Sweats, fever,
chills, progressive weakness, malaise, anorexia, and weight loss
characterize the continuing illness.
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[Although not related to bioterrorism, tularemia is a Category A
bioterrorism agent and the pneumonic form is likely to be the one
associated with intentional spread.
ProMED-mail thanks the Bureau of Communicable Disease of the NY City
Department of Health and Mental Hygiene for allowing posting of this case,
not yet in the public domain. ProMED-mail has posted 2 other cases of
pneumonic tularemia acquired in New York City over the past 10 years.
The Gateway National Recreation Area is in southern Brooklyn and can be
seen (in purple) on a map of the borough at
<http://www.wynn.com/bol/images/brooklyn.map.gif>. - Mod.LL]
[see also:
2007
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Tularemia - USA (UT, NJ) (05): UT 20070809.2590
Tularemia - USA (UT, NJ) 20070716.2283
Tularemia, lagomorphs - USA (NM) 20070622.2013
Tularemia, feline - USA (SD) 20070614.1938
Tularemia, feline - USA (CO) 20070524.1658
Tularemia, ovine - USA (ID) 20070428.1391
2006
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Tularemia, humans, rabbits - USA (WY) 20061101.3122
Tularemia, pneumonic - USA (MA) 20060731.2115
Tularemia, rabbits - USA (TX) 20060601.1531
Tularemia - USA (TX) (03) 20060224.0607
Tularemia, rodents, humans - USA (TX) (02): background 20060222.0577
Tularemia - USA (TX) 20060216.0508
Tularemia - USA (NE) 20060103.0024
2004
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Tularemia, pneumonic - USA (NYC)(04) 20041115.3081
Tularemia, pneumonic - USA (NYC) 20041110.3033
1998
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Tularemia - USA (New York City) (03) 19980804.1490
Tularemia - USA (New York City): RFI 19980724.1405]
.................ll/mj/sh
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