Dermatology Made Easy is based on the most popular topics from DermNet NZ's vast array of material. The book combines the essential focus of the ‘Made Easy’ book series with the authority and knowledge base of DermNet NZ's unparalleled resources.
Author: Marie Hartley, Staff Writer, 2009.
Tularaemia is an infection caused by a bacterium, called Francisella tularensis, which is transmitted by ticks and other animals. Various tick species are responsible for 9% to 57% of transmission. Other animals that can transmit F. tularensis include rabbits, squirrels, opossums, cats, muskrats, and mosquitoes.
F. tularensis is mainly found in the Northern hemisphere and has been reported in North America, Russia, Europe, the Middle East, China, and Japan. Tularaemia has recently received attention due to its potential as a biological weapon.
Two predominant strains of F. tularensis have been isolated; type A and type B. Type A causes more severe disease, causing death in up to 5% to 7% of untreated patients. Type B generally causes a milder illness, which can occasionally be symptom-free.
Various clinical subtypes of tularaemia have been described depending on the mode of transmission and organ systems involved.
|Ulceroglandular||F. tularensis penetrates the skin through a scratch, graze, or tick or insect bite. Most common form of tick-borne tularaemia. Causes a painful skin ulcer, with enlarged, inflamed nearby lymph nodes, or nodular lymphangitis (swellings beneath the skin that track along the course of lymph channels, swellings may be painful and ulcerate). Lymph nodes may become fluctuant (soft, fluid-like) and rupture.|
|Glandular||Causes enlarged lymph nodes without an ulcer.|
|Oculoglandular||Due to direct contamination of an eye, e.g. from a squeezed tick spraying blood directly into the eye.|
Other clinical subtypes include typhoidal (most lethal), pneumonic, oropharyngeal, and gastrointestinal.
Tularaemia can cause primary skin lesions (seen in ulceroglandular subtype) and secondary skin lesions (seen in all forms of tularaemia).
This develops at the point of entry after a 2 to 5 day incubation period. The lesion is a painful red papule (lump) that slowly enlarges and ulcerates within a few days. The ulcer has raised, hardened, ragged edges, and a sensitive base. A discharge may be present, and the ulcer may be covered by an eschar (scab) and/or be itchy. Over weeks to months the ulcer heals and is replaced by scar tissue.
The primary lesion caused by type B tularaemia infection may be less severe, e.g. crusting, but no ulcer.
Secondary lesions (called tularemids) develop in 8% to 20% of cases of tularaemia and take various forms:
|Tick-borne transmission||Transmission due to other animals|
|Primary lesion||Usually a single primary lesion at the site of the bite. Lesion occurs on a part of the body commonly affected by tick bites.||Multiple primary lesions, often on the arms and hands.|
Tularaemia is treated with antibiotics such as streptomycin, gentamicin, tetracyclines, chloramphenicol, and tobramycin. Streptomycin is generally the drug of choice, as it appears to offer the highest rate of cure with the lowest rate of relapse.
Secondary skin manifestations may require topical corticosteroids.
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