A strange fever from animals? Let's talk about 'Tularemia'!

Have you ever heard of a disease called ``Tularemia''? Maybe this name is a bit new. But it is something we need to know, because it is an infection that can be transmitted to us from animals, and it can be quite serious. Some people also call it "rabbit fever". So, don't worry, today we will talk about ``Tularemia'' in a simple way that you can understand.

What is 'Tularemia'? Simply put...

Tularemia is a disease caused by a bacterium called Francisella tularensis (F. tularensis). It is a zoonotic disease. More precisely, it is transmitted to humans by contact with infected animals or by contact with animals that carry the bacteria, such as fleas and ticks.

When you have this disease, your lymph nodes can become painfully swollen . Not only that, but depending on where the bacteria entered your body, you can also experience different symptoms in your lungs, eyes, throat, and intestines. Think about it, sometimes when we go for a walk in the forest, if a small animal scratches us or bites us, like a tick, we get a wound, and this bacteria can enter our body through that wound.

What does tularemia look like on the body?

The main symptom of tularemia is the swelling of the lymph nodes, which can appear as large lumps on the body, such as in the neck and armpits. Sometimes, an ulceration can occur where the bacteria entered the body. This means that it looks like a small sore.

Who is most likely to develop this 'tularemia'? Who is at risk?

Anyone can get tularemia. However, your job, hobbies, or the environment you live in may increase your risk of exposure to this bacteria. See if you are among these people:

• People who hunt or handle undercooked meat : This can be transmitted from animal meat.
• People who regularly work with animals, such as veterinarians and animal control officers : are at increased risk due to close contact with infected animals.
• People who live in environments with a high incidence of biting insects such as ticks and fleas .
• People with a weakened immune system : For example, people with HIV, cancer patients, or those taking immunosuppressant medications.
• Farm workers, sheep shearers, and those who work with the bacteria `F. tularensis` in laboratories : These people are at increased risk of developing `Pneumonic tularemia`, which affects the lungs.

Although this disease is widely reported in some countries, especially some states in the United States, anyone can contract this disease in any environment where this bacteria is present. Although it has not been reported to such a large extent in Sri Lanka, it is good for us to be careful.

How common is Tularemia?

It's not a disease that's seen everywhere in the world, it's a bit rare . But, as I said before, it can be quite serious if it occurs, so it's very important for us to be aware of this.

What parts of the body does this disease affect?

Tularemia can primarily affect your lymph nodes, skin, eyes, throat, gut, or lungs . However, in severe cases, it can cause inflammation in any organ, including the brain and heart.

How does this bacteria work inside the body?

Simply put, when the `F. tularensis` bacteria enter our bodies, the cells of our immune system "engulf" the bacteria. Normally, these cells would destroy the bacteria. However, the `F. tularensis` bacteria are very cunning. It is inside those cells that the bacteria multiply . Eventually, the immune cells are destroyed, and large numbers of the bacteria spread throughout the body, infecting other cells.

This destruction of cells and our immune system's response to this bacteria is what causes symptoms in the infected part of the body.

Are there different types of Tularemia?

Yes, there are several main types of tularemia. These are classified based on how you are infected with the bacteria and where the symptoms appear.

1. Ulceroglandular tularemia

This is the most common type of tularemia . It is usually contracted through the bite of an animal such as a tick or an infected animal. It affects your skin and sebaceous glands. The main symptom is a swollen sebaceous gland with a skin lesion.

2. Glandular tularemia

This is similar to the type mentioned above, but it does not cause skin lesions, only the gills swell . It can be caused by tick bites or direct contact with an infected animal.

3. Type affecting the eyes (Oculoglandular tularemia)

This type of infection occurs when you get infected water or an animal's bodily fluids into your eye. It causes symptoms in the eye . It usually affects only one eye.

4. The type that affects the throat and digestive tract (Oropharyngeal tularemia)

This type can be contracted by eating contaminated food, drinking contaminated water, or by putting bacteria-contaminated hands in the mouth without washing them. The main symptom is a severe sore throat . Sometimes gastrointestinal symptoms may also occur.

5. The type that affects the lungs (Pneumonic tularemia)

This is the most serious form of tularemia . It causes symptoms similar to pneumonia. There are two ways it can develop:

• Direct inhalation of the bacteria `F. tularensis`Entering the lungs.
• Spread of an F. tularensis infection elsewhere in the body to the lungs .

6. Typhoidal tularemia

This type of tularemia is characterized by a high fever and affects various parts of the body . It can develop in the same way as other types of tularemia.

Is 'Tularemia' the same as 'Lyme disease'?

This is a question that some people ask. Although some of the symptoms of ``Tularemia`` are similar to ``Lyme disease``, the two diseases affect the body differently. ``Tularemia`` is a disease that can affect various parts of the body and can even be life-threatening . ``Lyme disease`` is usually less life-threatening, but sometimes it can cause long-term, difficult-to-treat symptoms.

What are the symptoms of Tularemia?

The symptoms of tularemia vary depending on the type you have. Most types include fever and various types of skin rashes . In addition, specific symptoms occur depending on the location of the infection.

Characteristics of Ulceroglandular and Glandular types of skin lesions and nodules:

• Fever.
• Very large, painfully swollen lymph nodes.
• An open sore (ulcer or lesion) on the skin - this is only for `Ulceroglandular tularemia`.

Symptoms of the Oculoglandular type:

• Eye pain.
• Tearing of the eyes.
• Sensitivity to light (photophobia) - meaning it is difficult to look at light.
• Swelling and pain around the ears or neck.
• An open wound in the eye (corneal ulceration).

Symptoms of the Oropharyngeal type affecting the throat and esophagus:

• Fever.
• Severe sore throat .
• Throat swelling, redness, and white spots.

Some people may also experience:

• Vomiting.
• Diarrhea (possibly with blood).
• Abdominal pain.

Symptoms of the Pneumonic type affecting the lungs:

• Fever.
• Cough.
• Difficulty breathing (dyspnea).
• Chest pain or tightness.
• Muscle pain.
• Red bumps or lesions on the skin (erythema nodosum).
• Coughing up blood (hemoptysis).

Symptoms of Typhoid fever:

• High fever.
• Chills.
• Headache (headache).
• The food is tasteless.
• Muscle pain.
• Sore throat.
• Stomach pain.
• Diarrhea.
• Nausea or vomiting.
• Confusion.

How long does it take for the bacteria to enter the body before the disease appears?

The incubation period of tularemia, the time from exposure to the bacteria until symptoms appear, is usuallyAbout three to five days , but some people can go as long as two weeks without showing symptoms.

What is the cause of this disease 'Tularemia'?

As I mentioned earlier, it is caused by a bacterium called `Francisella tularensis` (`F. tularensis`). This bacterium usually lives in the bodies of animals (these disease-carrying animals are also called "reservoirs") – especially rabbits, hares, small animals such as mice, and cats. It can also be transmitted by ticks and biting insects.

There are two main types of this `F. tularensis` bacterium - type A and type B. Type A usually causes a more severe illness, and is most common in the Americas. Type B usually causes milder symptoms, and is found in North America and most other parts of the world.

How does this disease spread to us?

There are several ways in which Tularemia is transmitted to us:

• Bites from biting insects such as ticks, mosquitoes, and deer flies .
• By being bitten by infected animals.
• By touching infected animals . If you touch the tissue or body fluids of an infected animal, the bacteria can enter your body through a small break in your skin. You can also get the bacteria by touching objects contaminated with the `F. tularensis` bacteria and then touching your face, eyes, nose, or mouth.
• By drinking infected water or eating infected food.
• By breathing in small droplets (aerosol or mist) containing the bacteria `F. tularensis` . This can happen, for example, if an infected animal is cut by a lawnmower or farm equipment, and the germs can be released into the air and inhaled.

Is tularemia contagious from person to person?

No, tularemia is not contagious. That is, it is not spread by talking to or shaking hands with an infected person. However, it is highly infectious . That is, even if a very small amount of the bacteria enters the body, the risk of developing the disease is high.

Is it safe to eat an animal that has tularemia?

When meat is cooked thoroughly, bacteria are killed. However, if you know that an animal has had ``Tularemia'', it is not good to eat the meat of that animal .

How does a doctor diagnose Tularemia?

To diagnose tularemia, a doctor will examine you, ask about your symptoms, and order tests on your blood or other body fluids. Depending on your symptoms, he or she will examine your gums, throat, eyes, and skin for sores, lumps, or lesions.

What tests are being done for this?

To diagnose tularemia, your doctor may perform the following tests:

• Blood tests: A blood sample taken from your arm will be sent to a lab to be tested for signs of tularemia and to see if the F. tularensis bacteria are growing. Because the F. tularensis bacteria grow slowly, the first blood test may be normal. So you may need to have another blood test a few weeks later.
• A biopsy : If your rash is very swollen or there are skin lesions, your doctor will take a small piece of tissue (a `biopsy`) from the area and send it to a lab to see if the `F. tularensis` bacteria is present or growing.
• Nasal or throat swab : The doctor will use a swab attached to a long stick to take a sample of mucus from your nose or throat, send it to a lab, and check for the presence and growth of the F. tularensis bacteria.
• Pleural fluid test / thoracentesis : If you have a buildup of fluid around your lungs (pleural effusion), your doctor will take a sample of it through a procedure called thoracentesis and send it for testing.

Well, what are the treatments for this disease 'Tularemia'?

Tularemia is treated with broad-spectrum antibiotics . These may be given as an injection or as pills. If you have serious complications, you may need other treatments.

It is very important to start treatment for tularemia as soon as possible. Sometimes, doctors will start antibiotics before your lab reports are in because they want to stop it from getting serious.

Can people completely recover from this disease, Tularemia?

Yes, it is possible. Tularemia is a curable disease. Antibiotics can kill the bacteria that cause it.

What are the medications given for Tularemia?

The types of antibiotics used to treat tularemia are:

• `Streptomycin`
• `Gentamicin`
• ` Doxycycline (Doxycycline) `
• `Azithromycin`
• `Ciprofloxacin' or `levofloxacin'

How do I take care of myself at home while taking medication? How do I manage symptoms?

It is important to take all antibiotics prescribed by your doctor for the full prescribed period . Do not stop taking the medication until your doctor tells you to. If you stop taking antibiotics too soon, some of the bacteria may remain in your body and cause the infection to return.

In addition to prescribed antibiotics, you can manage some of the symptoms of tularemia at home. Ask your doctor about over-the-counter (OTC) medications or other treatments that can help with your symptoms.

What can we do to stay safe from this disease called 'Tularemia'?

You can reduce the risk of tularemia by protecting yourself and your pets from insect bites, being careful when interacting with animals, and cooking meat thoroughly.

• Whenever possible, wear clothing that covers your body well when outdoors, especially in tall grass or wooded areas. Use a bug spray containing DEET.
• After returning from the outdoors, check yourself and your pets for ticks . It's a good idea to have someone else check areas that you can't easily see, such as the head.
• Ask your veterinarian what you can do to protect your pets from ticks. Cats that go outside can get tularemia.
• Supervise your pets when they go outside. Tularemia can be transmitted through bites from other animals.
• Wear gloves when handling animals (living or dead) . Never touch a wild animal with your bare hands. Even if you wear gloves, wash your hands thoroughly with soap and water after handling animals.
• Cook meats thoroughly to a safe temperature . Always wash hands, surfaces, and utensils thoroughly after preparing food. Wild game can contain the bacteria that causes tularemia.
• Do not drink untreated water.
• If possible, avoid mowing or using other machinery near animal carcasses . If possible, do not expose any animals to machinery. Wearing a face mask when using a lawnmower or agricultural equipment may help prevent breathing in small particles in the air, but more research is needed to confirm this.
• If you think you may have been exposed to tularemia, ask your doctor if you should take antibiotics to prevent the disease from developing.

What happens if you get tularemia? How long does it take to recover?

Most people who get tularemia recover completely . You will need to take antibiotics for 10 to 21 days.

Depending on your symptoms, your doctor will monitor you closely for the first few days after starting treatment. If you start antibiotics too soon after your symptoms start, you may develop serious complications.

Some people's symptoms may come back after they have recovered (relapse). If that happens to you, you may need to take another course of antibiotics.

Treatment for tularemia usually takes two to three weeks. However, it may take longer to feel completely well. Sometimes, the skin lesions caused by tularemia can cause permanent scarring.

When can I go back to work/school?

Since tularemia is not contagious, you can return to work or school whenever you feel well .

What is the outlook for tularemia?

The outlook for tularemia is good if treated promptly . If treated promptly with antibiotics, the death rate from tularemia is less than 1%.

What are the possible complications of Tularemia?

Complications of tularemia usually occur with either pneumonic or typhoid fever. Some of these include:

• Severe difficulty breathing (Acute Respiratory Distress Syndrome - ARDS).
• Brain fever (meningitis or meningoencephalitis).
• Inflammation of the heart (`myocarditis`, `pericarditis` or `endocarditis`).
• Inflammation of the bones, bone marrow, or joints (osteomyelitis or arthritis).
• Inflammation of the liver (hepatitis).
• Renal failure.
• Internal bleeding (hemorrhage).

Can Tularemia be cured without antibiotics?

Some people can recover from tularemia without antibiotics. However, the risk of serious complications, including organ damage, is very high . If left untreated, type A tularemia can result in death in about 30% of cases. Therefore, if there is any doubt, it is wise to seek medical advice immediately.

When should I see a doctor?

See a doctor if you:

• If you have symptoms of 'Tularemia'.
• If you think you may have been exposed to tularemia, a doctor may recommend taking antibiotics to prevent the disease from developing.
• If symptoms of tularemia recur during or after treatment is completed.

When do you need to go to an Emergency Treatment Unit (ETU) ?

If you have these serious symptoms , go to the nearest emergency room immediately:

• If the fever is higher than 103 Fahrenheit (39.4 Celsius).
• Confusion or other mental changes.
• If there is blood in the vomit or stool.
• If you cough up blood.
• If you notice a blue color to your skin, lips, or fingernails (this is a sign of lack of oxygen - `hypoxia`).
• Severe stomach pain.
• Severe or sudden difficulty breathing.

What are the important things I should ask my doctor?

It's a good idea to ask these questions when you see your doctor:

• How do I take my medicine correctly?
• What can I do to relieve my symptoms at home?
• When should I come see you again?
• When should I go to the emergency room?

Has tularemia been used as a biological weapon?

Because it can be transmitted so quickly, there is concern that the bacterium F. tularensis, which causes tularemia, could be used as a biological weapon. However, there have been no reported or confirmed outbreaks of tularemia associated with bioweapons .

Finally, things to remember (Take-Home Message)

So, this 'Tularemia' is a rare, but sometimes serious disease that needs to be taken care of . If you think you have been exposed to it, or if you have symptoms, see a doctor immediately . If you get treatment quickly, you can make a full recovery. So, the most important thing is not to be afraid, but to be aware and careful. Got it?

` Tularemia, Francisella tularensis, rabbit fever, deer fly fever, zoonotic disease, lymph nodes, tick-borne disease, bacterial infection, tick-borne diseases