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{{Tularemia}}
{{Tularemia}}
{{CMG}} {{AE}} {{IMD}}
==Overview==
Tularemia may be classified according the original mode of [[transmission]]. The mode of [[transmission]] will ultimately dictate the resulting [[Symptoms and Signs|clinical manifestations]] associated with tularemia infections. There are five common forms of tularemia, they include ulceroglandular, [[Glandular|glandular,]] oculoglandular, oropharyngeal, and [[Pneumonic plague|pneumonic]].<ref name="Signs Sym">Centers for Disease Control and Prevention, Signs and Symptoms of Tularemia. http://www.cdc.gov/tularemia/signssymptoms/index.html Accessed March 1, 2016 </ref>


==Classification==
==Classification==
Tularemia clinically manifests in five common forms:
*[[Ulceroglandular]]
*[[Glandular]]
*Oculoglandular
*Oropharyngeal
*[[Pneumonic plague|Pneumonic]]<ref name="Signs Sym">Centers for Disease Control and Prevention, Signs and Symptoms of Tularemia. http://www.cdc.gov/tularemia/signssymptoms/index.html Accessed March 1, 2016 </ref>


Shown below is a table that classifies ''Tularemia'' infection based on the specific rickettsia organism responsible for infection. The classification of the organism responsible for infection dictates the choice of antimicrobial therapy.
 
The table below represents Tularemia clinical manifestations according to their distinct modes of transmission.


{| style="font-size: 85%;"
{| style="font-size: 85%;"
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Clinical Manifestation}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Organism}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Mode of Transmission}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Vector}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Endemic Regions}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Tularemia]]''' <ref name="Tulameria CDC”>  Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Francisella Tularensis''
| style="background: #DCDCDC; padding: 5px;" | ''D. Andersoni, D. Variabilis''
| style="background: #DCDCDC; padding: 5px;" | '''United States:'''
*Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Rocky Mountain Spotted Fever]]''' <ref name="RMSF CDC”>  Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |''Rickettsia Rickettsii''
| style="background: #DCDCDC; padding: 5px;" |''Wood Tick (Dermacentor Variabilis), D. andersoni''
| style="background: #DCDCDC; padding: 5px;" |'''United States:'''
*Eastern Region
*Southwest Region
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Helvetica Spotted Fever]]'''<ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia Helvetica''
| style="background: #DCDCDC; padding: 5px;" | ''Ixodes Ricinus (European)''
| style="background: #DCDCDC; padding: 5px;" |'''Europe:'''
*Sweden
*Switzerland
*France
*Laos
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Ehrlichiosis Anaplasmosis]]''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Ehrlichia Chaffeensis, E. Equi''
| style="background: #DCDCDC; padding: 5px;" | ''Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis''
| style="background: #DCDCDC; padding: 5px;" | '''United States:'''
*South Atlantic Regions
*South-central Regions
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Human neoehrlichiosis''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Neoehrlichia mikurensis''
| style="background: #DCDCDC; padding: 5px;" |  ''Lone Star Tick (''Amblyomma Americanum)'
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Europe
*Asia
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Rickettsiosis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia''
| style="background: #DCDCDC; padding: 5px;" |  ''No specific species identified''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*South Africa
*Morocco
*Mediterranean
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''African tick-bite fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia africae''
| style="background: #DCDCDC; padding: 5px;" |  ''Amblyomma, Dermacentor, and Rhipicephalus species''
| style="background: #DCDCDC; padding: 5px;" |'''Africa:'''
*Sub-Saharan
*West Indies
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Queensland tick typhus]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia austalis''
| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes species''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Australia
*Tasmania
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Q-fever (Typhus-like infection)]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Ulceroglandular
| style="background: #DCDCDC; padding: 5px;" | ''Coxiella burnetii (mimics the mechanisms of Rickettsia) ''
| style="background: #DCDCDC; padding: 5px;" |Transmitted by the bite of an infected tick or deer fly
| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes holocyclus and Amblyomma triguttatum''
| style="background: #DCDCDC; padding: 5px;" |'''Australia'''
*Widespread throughout Australia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever (Boutonneuse fever)''' <ref name="MSF”">Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Glandular]]
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia conorii''
| style="background: #DCDCDC; padding: 5px;" | Transmitted by the bite of an infected tick or deer fly, however skin [[ulcer]] does not form.
| style="background: #DCDCDC; padding: 5px;" |  ''Brown Dog Tick (Rhipicephalus sanguineus)''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Southern Europe
*Southern and Western Asia 
*Africa
*India
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Far Eastern spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Oculoglandular
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia heilong-jiangensis''
| style="background: #DCDCDC; padding: 5px;" | Transmitted through eye contact with infected animal meat. Either through rubbing of the eyes during the butchering process or fluid exposure.
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Far portions of Eastern Russia
*Northern portions of China
*Eastern Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Aneruptive fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="Aneruptive Fever”">Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Pneumonic plague|Pneumonic]]
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia helvetica''
| style="background: #DCDCDC; padding: 5px;" | Most dangerous form of tularemia, commonly transmitted through inhalation of material infected with the organism. May also occur if a tularemia infection is left untreated and spreads through the blood streams to the lungs. 
| style="background: #DCDCDC; padding: 5px;" |  ''Ixodes species''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Northern and Central portions of Europe
*Non-specific portions of Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Flinders Island spotted fever (Thai tick typhus)''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
|}<ref name="Signs Sym">Centers for Disease Control and Prevention, Signs and Symptoms of Tularemia. http://www.cdc.gov/tularemia/signssymptoms/index.html Accessed March 1, 2016 </ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia honei''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |''' Widespread in Independent Regions'''
*Australia
*Thailand
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Japanese spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia japonica''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Japan'''
*Widespread yet isolated to portions of Japan
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever-like disease''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia massiliae and R. monacensis''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
''R.massiliae induced:''
*France
*Greece
*Spain
*Portugal
*Switzerland
*Sicily
*Central Africa
*Mali
''R.monacensis induced:''
*Europe
*North Africa
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Maculatum infection'''
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia parkeri''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Americas:'''
*United States
*Portions of Canada
*South America
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Tick-borne necrosis and lymphadenopathy''' <ref name="TNL”">Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia raoultii''
| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor marginatus ''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Europe
*Asia
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''North Asian Tick Typhus''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Russia
*China
*Mongolia
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Lymphangitis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica mogolotimonae''
| style="background: #DCDCDC; padding: 5px;" |  'No specific species identified
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Southern France
*Portugal
*China
*Africa
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''TIBOLA''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="TNL”">TIBOLA acquired in Southwest Germany. Rieg S, Schmoldt S, Theilacker C, et al. Tick borne lymphadenopathy (TIBOLA) acquired in Southwestern Germany. BMC Infect Dis. 2011;11:167. http://www.ncbi.nlm.nih.gov/pubmed/21663601 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia slovaca''
| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor species''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
*Southern and Eastern Europe
*Asia
|}
 


==References==
==References==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Biological weapons]]
[[Category:Biological weapons]]
[[Category:Infectious disease]]

Latest revision as of 19:03, 18 September 2017


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

Tularemia may be classified according the original mode of transmission. The mode of transmission will ultimately dictate the resulting clinical manifestations associated with tularemia infections. There are five common forms of tularemia, they include ulceroglandular, glandular, oculoglandular, oropharyngeal, and pneumonic.[1]

Classification

Tularemia clinically manifests in five common forms:


The table below represents Tularemia clinical manifestations according to their distinct modes of transmission.

Clinical Manifestation Mode of Transmission
Ulceroglandular Transmitted by the bite of an infected tick or deer fly
Glandular Transmitted by the bite of an infected tick or deer fly, however skin ulcer does not form.
Oculoglandular Transmitted through eye contact with infected animal meat. Either through rubbing of the eyes during the butchering process or fluid exposure.
Pneumonic Most dangerous form of tularemia, commonly transmitted through inhalation of material infected with the organism. May also occur if a tularemia infection is left untreated and spreads through the blood streams to the lungs.

[1]

References

  1. 1.0 1.1 1.2 Centers for Disease Control and Prevention, Signs and Symptoms of Tularemia. http://www.cdc.gov/tularemia/signssymptoms/index.html Accessed March 1, 2016

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