c. Treatment. The specific antimicrobial therapy directed against the offending
rickettsial agents consists of tetracycline HCl (Tetracyn) which is the drug of choice or
chloramphenicol (Chloromycetin) which is effective. Chloramphenicol is used only if
tetracyclines are not available. It is not recommended because of the possibility of an
occasional complication of aplastic anemia. Supportive measures should be taken to
correct physiologic abnormalities and good nursing care should be provided since these
actions may be lifesaving in severe cases.
d. Prevention. Maintain strict hygienic measures in cow and sheep barns,
sheds, and laboratories. Ensure hygienic practices (pasteurization of milk). Educate
personnel who work in environments where Q-fever may occur. If pasteurization of milk
from cows, goats, or sheep is not possible, boil the milk at 71.7C (161F) for 15
seconds. Immunize those workers in hazardous occupations. Maintain dust control in
pertinent industries. Incinerate animal placentas, feces, and urine. Isolate victims and
autoclave their used articles that contained sputum and urine.
TULAREMIA (RABBIT FEVER, DEER-FLY FEVER, OHARA'S DISEASE)
a. General. Tularemia is an acute, plague-like infectious disease of wild
animals and man. It is caused by Francisella tularensis, a gram-negative bacteria.
Primary centers from which the disease develops have been identified in Canada, the
United States, Mexico, and Russia. The disease is found also in most European
countries as well as Turkey, Iran, China, Japan, and Tunisia. The disease is
transmitted in a variety of ways. People can contact tularemia by handling wild rabbits
and rodents such as muskrats who are infected. Drinking water from a stream on
whose banks an infected wild animal has died is another mode of transmission. Other
ways of transmission include inhaling dust from a substance (hay, for example;
contaminated with infected animal feces); contact with a domestic animal who is serving
as an accidental host; contact with infected ticks or other arthropods; and ingesting
infected, cooked meat.
b. Signs and Symptoms. Epidemics of tularemia have occurred in the United
States and Russia, but usually there are only occasional cases. The incubation period
is from two to 10 days, usually 3 days. General signs and symptoms include headache,
chills, nausea, vomiting, temperature between 103 and 104F, and severe prostration.
There are several clinical forms of tularemia; the form is determined by the portal of
entry of the agent causing the disease.
(1) Ulceroglandular tularemia. This is the most common form in the United
States. At the point of entry (arthropod bite, scratch by contaminated nails, or knife cut),
a lesion occurs; later this lesion develops into a necrotic ulcer with swelling of the
regional lymph nodes. The lymph node often suppurates and ulcerates. If the disease
is untreated, it lasts from three to five weeks. Convalescence, then, can last several
weeks or months with the patient having fever from time to time.