hey everyone this lesson is on the infectious disease known as tularemia in the scenario type of what causes this condition rustling talk about risk factors pathogenesis signs symptoms diagnosis and how we can treat it as well so tularemia is a zoonotic infection caused by the bacteria known as Frances Ella to Laurentiis so Frances Ella Trudeau rensis is a gram-negative aerobic bacteria and the condition of tularemia is also known as Francis's disease rabbit fever or deer fly fever there's many other names as well the transmission of this bacteria occurs through contact with infected animals so an example of this is through rabbits that's why it can be also called as a rabbit fever so rabbits and rodents can act as a reservoir for this bacteria you can also get this through tick bites so it take can bite you and can actually transmit this bacteria as well and some animal bites as well can also transmit this bacteria and another one is exposure to dead animals so the risk factors for this condition are related to the transmission so certain occupations are more at risk for getting tularemia certain occupations like veterinarians farmers hunters meat handlers and landscapers another risk factor is eating uncooked or undercooked wild meat particularly rabbit meat you can also see it through camping as well just because of the tick bites and other exposure to infected animals what is the pathophysiology of this condition it is a highly virulent bacteria so it actually only takes about 10 to 50 bacterium to cause an illness or infection and Frances ellaktor rinses is a Faculty of intracellular bacterium and it mentions before but it can actually live within particular cell types so it actually infects macrophages in a host so macrophages are cells responsible for phagocytosis and what happens is the macrophages actually phagocytize the bacteria like they're supposed to but the bacteria can survive inside those cells and actually replicate inside macrophages then they can also replicate inside neutrophils and through replication they continue to replicate and they essentially lead to a lysis the cells of the cell essentially dies and basically ruptures allowing the spread of these bacteria outside of that cell to infect other cells so they can continue to infect other macrophages and neutrophils what is the clinical presentation of tularemia tularemia actually has a very wide spectrum of science and symptoms it can be anywhere from asymptomatic to septic shock in death this actually has to do with the particular bacterial subspecies that causes the infection oftentimes might not be but there's actually two subspecies I didn't talk about before there's actually Francis L Aquila rensis subspecies two Laurentiis and there's also another sub species known as Francis L a to Lawrence's Hall Arctica so the Francis L a to Lawrence's cell species two Laurentiis can actually cause a more severe clinical presentation whereas the other subspecies doesn't cause as severe presentation when individuals do have symptoms the symptoms occur abruptly so there's an abrupt onset of symptoms after about an incubation period of around three to five days the symptoms are often nonspecific and they are systemic so there's systemic symptoms like fever chills malaise and fatigue those types of symptoms so there are actually six different forms of tularemia we're going to talk about each of these in detail so a lot of information coming up the first type is ulcer o glandular so if we break down the word all sorrow ulcer and glandular glands so has to do with in ulcer and glands so this is actually the most common form so as its name suggests there's a skin lesion and there's lymph adenopathy so swollen tender lymph nodes so you can see here in the posterior cervical chain you can see there's some lymph adenopathy here we also see fever with this form of tularemia and we also see a usually single erythema tiss ulcer that is slightly raised with a central area of eschar at site of inoculation so wherever the perhaps that tick had bitten you might see something like this this kind of raised ulcer and you may also see some subcutaneous nodules as well and again this has tender regional lymph adenopathy so we oftentimes see it in the cervical chains and we can also see it as a occipital lymph node that is enlarged and tender as well and these lymph nodes can also become suppurative the second form of tularemia is glandular so again just look at the name all it really means is that there is glands involved this is actually the second most common form we have tender regional lymph adenopathy very similar to the first form we talked about again these lymph nodes may become suppurative but there's no identifiable skin ulcer so we see the lymph adenopathy usually again cervical and we might also see an occipital tender lymph node but no identifiable skin ulcer so that's the second most common form the third form of tularemia is ocula Langella so break it down again ocula something to do with the eye gland again the lymph nodes so this actually has both glandular component and ocula or ocular components so there's an infection of the conjunctiva of the eyes usually through rubbing of the eyes so if you have bacteria on your hands and you rub your eyes that may be a way to introduce the bacteria into the conjunctiva it may occur through aerosols as well usually it's unilateral so one eye is being affected whereas the other one is okay it may send see something like this there's a red swollen eye with chemo psious and a runny eye so we can see pain and photophobia so photophobia is just a sensitivity to light and again increased tearing we can also see again because there's glandular in the named tender regional lymph adenopathy so again very similar to before you may see other types of lymph adenopathy not the cervical but more pre auricular posterior auricular being involved it can also see cervical chain being involved and in fact that I may also have some corneal ulceration as well the fourth common type of tularemia is pharyngeal so Varon Geel pharyngeal means it's about the throat so this actually occurs through direct jes tchen of the bacteria contaminated food or drink so the mouth and throat are involved we have a fever sore throat neck swelling so usually we see exudative pharyngitis exudative means that there's just this white exudate and the pharyngitis it's a it's a sore throat essentially Farren's means throat itis is inflammation information of the throat again we can also see cervical lymph adenopathy and we also may see pharyngeal or tonsillar ulcers v presentation of tularemia is known as pneumonic tularemia there's primary secondary pneumonic tularemia primary is essentially when you breathe in the bacteria into your lungs directly it's a direct contact from the bacteria into the lungs this can occur in farmer's lab workers sheep shearers so with primary pneumonic you tularemia these patients can have fever and cough malaise so they can be very tired and they can have myalgia so sore and achy muscles and if we were to take a look at a chest x-ray we can see pulmonary infiltrates lobar consolidation pleural effusion and we can see hilar adenopathy so we can see hilar adenopathy here it's actually bilateral it may actually look like sarcoidosis but you can see hilar adenopathy with pneumonic tularemia and the other presentation is secondary pneumonic tularemia this usually occurs from another site being infected with the francis la2 Laurence's bacteria the bacteria can travel through the blood so hematogenous lee and it can go into the lungs causing a secondary pneumonic tularemia usually it's bilateral lower lobe involvement with this type of presentation and with both of these with pneumonic tularemia in general the skin finding of erythema nodosum is more common and the sixth clinical presentation of tularemia is known as typhoid or so typhoid all tularemia it's a systemic febrile illness so patient has fatigue and malaise they have a fever and chills but they have some other symptoms as well the big key thing about typhoid --all tularemia is that they don't have regional lymph adenopathy basically all the other clinical presentations have when fan APPA the-- somewhere but this type does not so this is the big key component to recognize with high photo tularemia there is no regional lymphadenopathy present we can see fever and chills with typhoid all tularemia anorexia so they have very low appetite headaches biologist so again sore muscles sore throat cough and abdominal pain and diarrhea so these are the the key symptoms you want to think about here abdominal pain and diarrhea so these are very different than the other clinical presentations and oftentimes they can have very diffuse abdominal tenderness and if any or all of these presentations are not treated appropriately or they are left untreated individuals with these conditions can have chronic and recurrent fevers have long standing fatigue anorexia or low appetite weight loss and weakness so these symptoms can last a long time if this condition is not treated properly so these symptoms can last for months so it's important to be able to diagnose this condition and treat it appropriately so how do we make the diagnosis so the diagnosis of tularemia is oftentimes suspected based on the symptomatology and risk factors and some of the other things we talked about earlier in this presentation so think about those six forms of tularemia if they've got a skin ulcer and that's some regional lymph adenopathy and they get some risk factors you can think about this as a possible diagnosis you can think about some of the other symptoms in those different types of tularemia to help you come up with a suspicion that this might be tularemia more specifically though we could diagnose tularemia with serology testing so looking for positive antibody titers to Frane Selak you know rensis you can do a bacterial culture although this bacteria is very difficult to culture so this may not be a good test to use and there are some new testing with PCR polymerase chain reaction to actually assess to see if this bacteria is present so once we make the diagnosis how do we treat tularemia so treatment involves using streptomycin or gentamicin usually through intramuscular routes fluoroquinolones are also known to be effective in cyclones as well so these are the antibiotics we can use to treat the tularemia so the key is to actually make the diagnosis of tularemia in the first place this is something we call a master of disguises it can look like many different types of conditions so and it has many different clinical presentations so it's important to have at least a basic knowledge of what this condition might look like especially in infectious disease environments and with regards to individuals who are at risk for getting this condition so it's good to know about at least a brief overview of this condition and once we make the diagnosis it's important to understand the treatments they are a bit odd streptomycin and gentamicin fluoroquinolones and tetracyclines can be used as well and if this is not treated properly we can have long-standing issues with fever and fatigue and weight loss and other issues that can last for months and months if you want to learn more about other infectious diseases please check out Q fever and Lyme disease these also can have very odd nonspecific presentations as well and if you found this lesson helpful please consider giving it a thumbs up and subscribing to the channel and in all support is greatly appreciated and as always continue to live laugh and learn and I hope to see you next time