Affiliation:
1. Epidemic Intelligence Service, Division of Scientific and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
2. Arkansas Department of Health, Little Rock
3. Arkansas Children’s Hospital, Little Rock; and
4. University of Arkansas for Medical Sciences, Little Rock
Abstract
Abstract
Background
Francisella tularensis, although naturally occurring in Arkansas, is also a Tier 1 select agent and potential bioterrorism threat. As such, tularemia is nationally notifiable and mandatorily reported to the Arkansas Department of Health. We examined demographic and clinical characteristics among reported cases and outcomes to improve understanding of the epidemiology of tularemia in Arkansas.
Methods
Surveillance records on all tularemia cases investigated during 2009–2013 were reviewed.
Results
The analytic dataset was assembled from 284 tularemia reports, yielding 138 probable and confirmed tularemia cases during 2009–2013. Arthropod bite was identified in 77% of cases. Of 7 recognized tularemia manifestations, the typhoidal form was reported in 47% of cases, approximately double the proportion of the more classic manifestation, lymphadenopathy. Overall, 41% of patients were hospitalized; 3% died. The typhoidal form appeared to be more severe, accounting for the majority of sepsis and meningitis cases, hospitalizations, and deaths. Among patients with available antibiotic data, 88% received doxycycline and 12% received gentamicin.
Conclusions
Contrary to expectation, lymphadenopathy was not the most common manifestation observed in our registry. Instead, our patients were more likely to report only generalized typhoidal symptoms. Using lymphadenopathy as a primary symptom to initiate tularemia testing may be an insensitive diagnostic strategy and result in unrecognized cases. In endemic areas such as Arkansas, suspicion of tularemia should be high, especially during tick season. Outreach to clinicians describing the full range of presenting symptoms may help address misperceptions about tularemia.
Funder
Arkansas Department of Health
Centers for Disease Control and Prevention
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Reference28 articles.
1. Tularemia in children;Jacobs;Pediatr Infect Dis,1983
2. Tularemia;Foley;Vet Microbiol,2010
3. Francisella tularensis (Tularemia);Penn,2010
4. Tularemia: current epidemiology and disease management;Eliasson;Infect Dis Clin North Am,2006
5. Tularemia;Ellis;Clin Microbiol Rev,2002
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