Tularemia is a zoonotic infection with natural foci. It is characterized by intoxication, fever, damage to the lymph nodes. The causative agent of the disease is a small bacterium. When heated to 60C, it dies in 5-10 minutes. Tularemia bacillus reservoirs are hares, rabbits, water rats, voles. Epizootics periodically appear in natural foci.

The infection is transmitted to humans either directly by contact with animals (hunting), or through contaminated food and water, less often by aspiration (when processing grain and forage products, threshing bread), by blood-sucking insects (gadfly, tick, mosquito, etc.).

Symptoms and course of tularemia. The incubation period is from several hours to 3-7 days. There are bubonic, pulmonary and generalized (spread throughout the body) forms. The disease begins acutely with a sudden rise in temperature to 38.5-40C. There is a sharp headache, dizziness, pain in the muscles of the legs, back and lumbar region, loss of appetite. In severe cases, there may be vomiting, nosebleeds. Severe sweating, sleep disturbance in the form of insomnia or vice versa drowsiness are characteristic. Often there is euphoria and an increase in activity against the background of high temperature. There is redness and swelling of the face and conjunctiva already in the first days of the disease. Later, petechial hemorrhages are found on the oral mucosa. The tongue is covered with a grayish coating. A characteristic symptom is an increase in various lymph nodes,

From the side of the cardiovascular system, bradycardia and hypotension are noted. In the blood, leukocytosis with a moderate neutrophilic shift. The liver and spleen are not enlarged in all cases. Pain in the abdomen is possible with a significant increase in mesenteric lymph nodes. The fever lasts from 6 to 30 days.

Bubonic form of tularemia . The causative agent penetrates the skin without leaving a trace; after 2-3 days of the disease, regional lymphadenitis develops. Buboes are a little painful and have clear contours up to 5 cm in size. Subsequently, either softening of the bubo occurs (1-4 months), or its spontaneous opening with the release of thick creamy pus and the formation of a tularemia fistula. The axillary, inguinal, and femoral lymph nodes are most commonly affected.

The ulcerative-bubonic form is characterized by the presence of a primary lesion at the site of the entrance gate of infection.

The oculo-bubonic form develops when the pathogen enters the mucous membranes of the eyes. The appearance of yellow follicular growths up to millet grain size on the conjunctiva is typical. Bubo develops in the ear or submandibular areas, the course of the disease is long.

The anginal-bubonic form occurs with a primary lesion of the mucous membrane of the tonsils, traditionally one. Occurs during the food route of infection.

There are forms of tularemia with a predominant lesion of internal organs. Pulmonary form – more often recorded in the autumn-winter period. The generalized form proceeds according to the type of general infection with severe toxicosis, loss of consciousness, delirium, severe headache and muscle pain.

Complications of tularemia can be specific (secondary tularemia pneumonia, peritonitis, pericarditis, meningoencephalitis), as well as abscesses, gangrene caused by secondary bacterial flora.

Diagnosis of tularemia is based on a skin-allergic test and serological reactions.

Treatment of tularemia. Hospitalization of the patient. The leading place is given to antibacterial products (tetracycline, aminoglycosides, streptomycin, levomycetin), treatment is carried out up to 5 days of normal temperature. With prolonged forms, combined antibiotic treatment with a vaccine is used, which is administered intradermally, intramuscularly at a dose of 1-15 million microbial bodies per injection at intervals of 3-5 days, the course of treatment is 6-10 sessions. Recommended vitamin therapy, repeated transfusions of donor blood. When fluctuation of the bubo appears, surgical intervention (wide incision and emptying of the bubo) is performed. Patients are discharged from the hospital after a complete clinical recovery.

Prevention of tularemia. Elimination of natural foci or reduction of their territories. Protection of dwellings, wells, open reservoirs, products from mouse-like rodents. Carrying out mass planned vaccination in the foci of tularemia.

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