Confirmed case of Tularemia in Sudbury district
Advisory Alert
November 6, 2015
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Dear Colleagues,
I am writing today to inform you of a confirmed case of tularemia in an adult resident of the Sudbury District. This is the first human case of tularemia in the Sudbury & District Health Unit’s service area since 2003. It is believed that the individual became infected through contact with wild game. This advisory alert provides information on the clinical management of suspected tularemia cases.
Etiology and Epidemiology
Tularemia is a zoonotic bacterial disease caused by the bacterium Francisella tularensis (F. tularensis), which is a small, Gram-negative, non-motile coccobacillus with is known to naturally circulate in Ontario wildlife populations, particularly rabbits, hares, voles, muskrats, beavers, and squirrels and in ticks and small domestic animals.
While human cases of tularemia have been reported throughout North America, it is very rarely reported in Ontario. Two human cases were reported in Ontario from 2007 to 2011, both of which were reported in 2010.
Many routes of human exposure to tularemia are known to exist; the common routes include inoculation of the skin or mucous membranes with blood or tissue of animals, while handling infected animals; bites from infected deerflies or ticks; and handling or eating insufficiently cooked meat of infected animals. Hunters are at higher risk of exposure because of the handling of wild game carcasses.
Less common means of spread include drinking contaminated water, inhaling dust from contaminated soil or inoculation of the skin with contaminated soil, contact with contaminated animal pelts or paws, and handling sick domestic pets.
Transmission of F. tularensis from person to person has not been reported.
The incubation period for tularemia is related to size of inoculum and is typically 3 to 5 days, but may range from 1 to 14 days.
Clinical Presentation
Clinical presentation is typically sudden with an abrupt onset of fever, chills, myalgia and headache. Illness usually conforms to one of several tularemic syndromes, associated with route of exposure, and include the following:
- Ulcero-glandular – cutaneous ulcer with regional lymphadenopathy at the entry site (most common)
- Glandular – regional lymphadenopathy with no ulcer
- Oculo-glandular – conjunctivitis with preauricular lymphadenopathy
- Oropharyngeal – stomatitis or pharyngitis, or tonsillitis and cervical lymphadenopathy
- Intestinal – intestinal pain, vomiting, and diarrhea
- Pneumonic – primary pleuropulmonary disease
- Typhoidal – febrile illness without early localizing signs and symptoms
Symptom severity can range from mild to life-threatening. The elderly, people with respiratory illness or immune-compromised individuals are most at risk of developing severe illness.
Laboratory Diagnosis
Laboratory diagnosis is confirmed by isolation of F. tularensis in a clinical specimen or a fourfold or greater change in serum antibody titer to F. tularensis antigen.1
For sending specimens to the Central Public Health Laboratory, physicians must call 416.235.6556 or 877.604.4567 during work hours and 416.605.3113 after work hours prior to submission.
Specimens should be handled according to universal precautions and packaged for transport to the Central Public Health Laboratory according to the Transportation of Dangerous Good regulation.
Treatment
Streptomycin or gentamycin given for 7 to 14 days is the drug of choice.1
Reporting
Under the Health Protection and Promotion Act, both suspected and confirmed cases of tularemia must be reported to the Medical Officer of Health.
Should you have any further questions, please contact the Sudbury & District Health Unit at 705.522.9200, ext. 464.
Reference:
- Ministry of Health and Long-Term Care. (2003, January). Diseases: Tularemia. Retrieved from http://www.health.gov.on.ca/english/providers/pub/disease/tularemia.html
This item was last modified on September 9, 2016