July 22, 2008
TULAREMIA DIAGNOSED IN AN ATLANTIC COUNTY RESIDENT
The New Jersey Department of Health and Senior Services (NJDHSS) and the Atlantic County Division of Public Health would like to notify the medical community of a newly diagnosed case of tularemia infection in a 4-year-old Atlantic County resident. While rare, tularemia, caused by the bacterium Fransicella tularensis, is endemic to the United States and should be considered in the differential diagnosis of an acute, severe febrile illness.
On July 1, the case-patient was bitten by a tick which was removed later that day. Within days (5-10) symptoms developed including persistent fever (102º to 106ºF), headache, malaise, tender preauricular erythematous swelling and a small ulcer at the bite area. On July 15, the case-patient was admitted to a Philadelphia hospital with the initial diagnosis of ulceroglandular tularemia and started on antibiotic therapy. A specimen collected from the ulcer site was PCR-positive for Francisella tularensis. Chest x-ray examination was normal and results of blood serology are pending. Case-patient was discharged to home and is recovering.
Although tularemia is listed as a potential bioterrorism agent by the federal Centers for Disease Control and Prevention (CDC), there is no evidence to suggest that this case is related to bioterrorism. The case-patient lives and attends daycare locally with frequent outdoor activities. Travel during the weeks prior to onset was limited to the South Jersey area. No other family members report illness consistent with tularemia.
Fewer than 200 cases of tularemia are reported annually in the United States - mainly in western and south central states. Since 2000, there have been four (4) confirmed cases (including this case) of tularemia reported: all have occurred in residents of southern New Jersey (Camden [1], Cape May [2], Atlantic [1]).
Tularemia, also known as "rabbit fever," is a rare, potentially serious illness caused by the bacterium Francisella tularensis, which occurs widely in nature and can affect animals, particularly rodents and rabbits. Tularemia can be acquired in multiple ways, such as being bitten by an infected tick, handling infected animal carcasses, eating or drinking contaminated food or water, or inhaling the bacteria.
The clinical manifestations of tularemia vary in severity and presentation according to route of introduction and virulence of the agent. The onset of disease is typically sudden and influenza-like, with high fever (100.4°F-104°F), chills, fatigue, general body aches, headache, and nausea. Most often, tularemia presents with large, tender lymph nodes and a non-healing skin ulcer at the site of introduction of the bacteria (ulceroglandular type). This form typically arises from handling a contaminated carcass or following an infective tick bite.
The American dog tick and the Lone Star tick, both found locally are known to carry tularemia.
Several precautions can protect individuals from tularemia:
. Avoid drinking, bathing, swimming or working in untreated water where infection may be common among wild animals.
. Use impervious gloves when skinning or handling animals, especially rabbits.
. Cook the meat of wild rabbits and rodents thoroughly.
. Wear light-colored, tightly woven clothing to make it easier to spot ticks; tuck shirts into pants and pants into socks; wear closed shoes/sneakers rather than open sandals.
. Use a tick repellent. Remind children to ask an adult to apply the tick repellent and DO as directed. Products should contain DEET (for clothing OR skin) or Permethrin (for clothing ONLY - do NOT apply to hands or face). Use products with less than 10% DEET and always follow manufacturers' directions carefully. Do NOT use repellents on children under 3 years of age.
. While outside, stay in the center of trails; avoid low bushes and leafy brush; periodically check clothing and skin for ticks and remove them.
. Once inside, check clothing, skin, and hair for ticks (take special note of your child's navel, underarm, groin area and behind the ears). If a tick is found, remove it carefully with tweezers, bag it and take it to your local medical facility for identification.
Following these precautions will not only decrease one's risk of tularemia, but also that of other tick-borne diseases, such as Lyme disease, Ehrlichiosis, Babisiosis and Rocky Mountain spotted fever.
For more information about tularemia or tick bite prevention, please contact the Atlantic County Division of Public Health at (609) 645-5933 or NJDHSS at 609-588-7500 or visit http://www.state.nj.us/health/er/tularemia.shtml and http://www.aclink.org/PublicHealth/mainpages/ticks.asp
TULAREMIA DIAGNOSED IN AN ATLANTIC COUNTY RESIDENT
The New Jersey Department of Health and Senior Services (NJDHSS) and the Atlantic County Division of Public Health would like to notify the medical community of a newly diagnosed case of tularemia infection in a 4-year-old Atlantic County resident. While rare, tularemia, caused by the bacterium Fransicella tularensis, is endemic to the United States and should be considered in the differential diagnosis of an acute, severe febrile illness.
On July 1, the case-patient was bitten by a tick which was removed later that day. Within days (5-10) symptoms developed including persistent fever (102º to 106ºF), headache, malaise, tender preauricular erythematous swelling and a small ulcer at the bite area. On July 15, the case-patient was admitted to a Philadelphia hospital with the initial diagnosis of ulceroglandular tularemia and started on antibiotic therapy. A specimen collected from the ulcer site was PCR-positive for Francisella tularensis. Chest x-ray examination was normal and results of blood serology are pending. Case-patient was discharged to home and is recovering.
Although tularemia is listed as a potential bioterrorism agent by the federal Centers for Disease Control and Prevention (CDC), there is no evidence to suggest that this case is related to bioterrorism. The case-patient lives and attends daycare locally with frequent outdoor activities. Travel during the weeks prior to onset was limited to the South Jersey area. No other family members report illness consistent with tularemia.
Fewer than 200 cases of tularemia are reported annually in the United States - mainly in western and south central states. Since 2000, there have been four (4) confirmed cases (including this case) of tularemia reported: all have occurred in residents of southern New Jersey (Camden [1], Cape May [2], Atlantic [1]).
Tularemia, also known as "rabbit fever," is a rare, potentially serious illness caused by the bacterium Francisella tularensis, which occurs widely in nature and can affect animals, particularly rodents and rabbits. Tularemia can be acquired in multiple ways, such as being bitten by an infected tick, handling infected animal carcasses, eating or drinking contaminated food or water, or inhaling the bacteria.
The clinical manifestations of tularemia vary in severity and presentation according to route of introduction and virulence of the agent. The onset of disease is typically sudden and influenza-like, with high fever (100.4°F-104°F), chills, fatigue, general body aches, headache, and nausea. Most often, tularemia presents with large, tender lymph nodes and a non-healing skin ulcer at the site of introduction of the bacteria (ulceroglandular type). This form typically arises from handling a contaminated carcass or following an infective tick bite.
The American dog tick and the Lone Star tick, both found locally are known to carry tularemia.
Several precautions can protect individuals from tularemia:
. Avoid drinking, bathing, swimming or working in untreated water where infection may be common among wild animals.
. Use impervious gloves when skinning or handling animals, especially rabbits.
. Cook the meat of wild rabbits and rodents thoroughly.
. Wear light-colored, tightly woven clothing to make it easier to spot ticks; tuck shirts into pants and pants into socks; wear closed shoes/sneakers rather than open sandals.
. Use a tick repellent. Remind children to ask an adult to apply the tick repellent and DO as directed. Products should contain DEET (for clothing OR skin) or Permethrin (for clothing ONLY - do NOT apply to hands or face). Use products with less than 10% DEET and always follow manufacturers' directions carefully. Do NOT use repellents on children under 3 years of age.
. While outside, stay in the center of trails; avoid low bushes and leafy brush; periodically check clothing and skin for ticks and remove them.
. Once inside, check clothing, skin, and hair for ticks (take special note of your child's navel, underarm, groin area and behind the ears). If a tick is found, remove it carefully with tweezers, bag it and take it to your local medical facility for identification.
Following these precautions will not only decrease one's risk of tularemia, but also that of other tick-borne diseases, such as Lyme disease, Ehrlichiosis, Babisiosis and Rocky Mountain spotted fever.
For more information about tularemia or tick bite prevention, please contact the Atlantic County Division of Public Health at (609) 645-5933 or NJDHSS at 609-588-7500 or visit http://www.state.nj.us/health/er/tularemia.shtml and http://www.aclink.org/PublicHealth/mainpages/ticks.asp
