Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is tularemia?
- What are the different types of tularemia?
- What causes tularemia?
- What are symptoms and signs of tularemia?
- How is tularemia diagnosed?
- What is the treatment for tularemia?
- Tularemia and bioterrorism
- Is there a vaccine for tularemia?
- Where can people find more information about tularemia?
- Tularemia At A Glance
- Find a local Infectious Disease Specialist in your town
How is tularemia diagnosed?
The first step in diagnosing tularemia is to suspect the disease. Because tularemia is rare, physicians may not think to ask about a history of tick bite or an occupational exposure such as hunting. Tissues or blood may be sent for culture, which requires special media. It is critical to warn the laboratory that tularemia is suspected because the organism poses a threat to laboratory workers. More rapid diagnosis may be obtained through use a polymerase chain reaction (PCR) test, although this may be falsely negative in up to one-third of cases. Other rapid tests under study include special fluorescent stains, tests that detect parts of the bacteria in the urine, and experimental tests for bacterial RNA. Infected patients make antibodies against F. tularensis and these antibodies may be detected in the blood after the first week of illness. High titers of antibodies indicate a high likelihood of disease. However, antibodies may simply represent disease that happened in the remote past rather than an acute illness.
What is the treatment for tularemia?
Tularemia is treated with a drug called streptomycin. The drug is given intramuscularly, twice a day, for one to two weeks. Gentamicin is an alternative drug and may be given intravenously. Neither of these drugs is effective against meningitis because they do not penetrate from the bloodstream into the brain. In tularemic meningitis, it may be necessary to put gentamicin directly into the fluid that bathes the brain.
Learn more about: streptomycin
The oral medications doxycycline (Vibramycin) or tetracycline (Sumycin) may work but are less effective than streptomycin. The disease may relapse after treatment with these pills. Other drugs, such as ciprofloxacin (Cipro), are effective in the test tube but have not been widely used in patients. However, one outbreak in Spain with 142 patients showed good clinical outcomes with ciprofloxacin; fluoroquinolones may be useful in treating tularemia if additional studies show clinical effectiveness.
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