Clinical Microbiology II MLTS 143 Matthew Coburn 30 Aug 10

1. Source (and date of source) and why it got your interest: I read about it in an article posted on 13 Aug 2010 on the BioPrepWatch website. This article grabbed my attention because in class we have learned that this bacterium is considered a possible means of bioterrorism and it is carried by many animals that I, as a hunter and an avid outdoorsman, could be potentially exposed to. 2. Organism plus Diseased caused: Francisella tularensis, causative agent of Tularemia (also known as rabbit fever) (1, 2, 3, 5). 3. Description: Francisella tularensis are tiny, pleomorphic, gram-negative, intracellular coccobacilli (1, 2). When gram stained, they stain very faintly, are approximately 0.2 by 0.2-0.7 micrometers, and are seen mostly as single cells (1, 2). The colonial morphology for this organism is 1-3mm, grayish-white to bluish-grey opaque colonies, with smooth and flat surface after 42 hours on chocolate, Thayer-Martin, and horse blood agars (1). 4. How the organism is detected: This organism is identified through its characteristic gram stain (1). If it is suspected, cultures should be held for 28 days, as it is a slow grower (1). Test to help confirm a suspicion include finding the organism oxidase positive, catalase positive, non-motile, and has the ability to rapidly hydrolyze urea (1, 2). If these test help confirm the technologists suspicion, then the organism should be sent to a level III lab for serological testing to confirm (1). 5. Treatment: Gentamicin or Streptomycin are the drugs of choice, with Tetracycline working in some cases as well (1). A patent for a new vaccine against Francisella tularensis has been award, and live vaccine strain is currently available (4, 5). 6. Why is it a public health concern? Though normally found in populations of wild animals (such as rabbits, voles, beavers, etc.), when made into an aerosol, Francisella tularensis is highly infectious. This characteristic makes governments wary that it could be used as a bioterrorism weapon. If 50kg of the organism was released as an aerosol over a large city, over 125,000 people would be incapacitated while another 19,000 would die (2). This organism is very pathogenic; only as few as 10 organisms are required to cause the disease tularemia (2). Naturally occurring transmission through aerosols can occur naturally in rural areas (2). As the bacteria is often found infecting small animals, naturally occurring infections can happen either through direct contact, ingestion of infected tissues, or through indirect contact and transmission via ticks, deerflies, or fleas (3, 5). This means of transmission has occurred recently in California, where a boy was bitten by an infected tick, though the disease of tularemia is rare (3). Tularemia is a concern for people who frequent the outdoors in areas where infected animals are known to be, people who work with animals that are likely infected (trappers for example), and laboratory workers who are exposed to this organism (5). There are a few ways that tularemia can present itself. The most common is called ulceroglandular tularemia, which is the result of the patient being inoculated through the dermis via a bite or handling infected material (2, 5). This type of tularemia presents with chills, headaches, cough, and chest pains (2). Lesions also form at the site of entry and persist for weeks or months. It can take months of a patient to recover completely and fatalities are rare (2). The less common forms of the disease are the oculoglandular, oropharyngeal, gastrointestinal, and inhalational disease (2). The most severe is the inhalational disease which presents with atypical pneumonia, pleuritis, fever, headache, chills, aches, sore

Clinical Microbiology II MLTS 143 Matthew Coburn 30 Aug 10

throat, and general malaise (2, 5). These symptoms can develop within 3-5 days, but the incubation period could be as long as 2 weeks (1, 5). The symptoms can also progress onwards to dyspnea, hemoptysis, sepsis, and shock (2). Mortality rates for inhalational tularemia can be up to 30-60% in the untreated. With treatment, the mortality rate drops to 2% (2).

7. References 1. Kipke, Leila. Clinical Microbiology I (course pack). Northern Alberta Institute of Technology (CNC); 2006: p.16-17 Module F. 2. Lehman DC, Mahon CR, Manuselis G. Textbook of Diagnostic Microbiology. 3rd edition. St. Louis: Saunders; 2007: p.480-481, 872-874.

3. Small bites, big disease. News Review [online]. 2010 Aug 12 [cited 2010 Aug 30]; Available from http://www.newsreview.com/sacramento/content?oid=1485456 4. Scientists awarded patent for tularemia vaccine. BioPrepWatch [online]. 2010 Aug 13 [cited 2010 Aug 30]; Available from http://www.bioprepwatch.com/news/214619-scientists-awarded-patent-for-tularemia-vaccine 5. Tularemia Fact Sheet. Center for Biosecurity [online]. 2007 Nov 19 [cited 2010 Aug 30]; Available from http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/tularemia.html