#idboardreview 70 F presents w/ fever, myalgia, dyspnea: CXR RLL pneumonia/effusion, resp fail leading to death. Her dog recently died who was seen with rabbit caracass. Diagnosis? #medEd #idmedEd #idtwitter
#tularemia transmission via tick (dog tick, wood tick & lone star tick) or deer fly bite, handling infected animals, inhaled contaminated aerosole or dust (mowing over animals), contaminated water, potential for bioterrorism
#tularemia types cdc.gov/tularemia/sign…
ulceroglandular
glandular
oculoglandular
oropharyngeal
pneumonic
typhoidal
#tularemia dx: culture is definitive. Clinical suspicion leads to appropriate specimens: swabs or scrapings of skin lesions, lymph node aspirates or biopsies, pharyngeal swabs, sputum specimens, gastric aspirates. Paradoxically, blood cultures are often negative.
#tularemia serology (4x increase in 4 wks), PCR can be helpful. Tx: streptomycin x10d. Alternative: tetracycline x14d
#tularemia Francisella tularensis tiny, faintly staining, pleomorphic gram-negative coccobacillus, aerobic nonmotile, nonsporulating cidrap.umn.edu/infectious-dis…

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