Violence... The story so far

June 2002; Revised Dec 2003

Tularemia Symptoms and other information available here.

Fever, chills, headache, and general weakness and less commonly, chest pain, weight loss, and dry cough are typical symptoms. Other symptoms include muscle pains, shortness of breath, joint stiffness, enlarged lymph nodes in the groin area, weight loss, and sweating.

Weaponized Tularemia

Tularemia is the most infectious of the bioweapons. It is easily produced and applied as a bioweapon. Aerosols are an efficient mode of delivery and result in the highest casualty rate.

We quote from the Journal of the American Medical Association

"A weapon using airborne tularemia would likely result 3 to 5 days later in an outbreak of acute, undifferentiated febrile illness with incipient pneumonia, pleuritis, and hilar lymphadenopathy. Specific epidemiological, clinical, and microbiological findings should lead to early suspicion of intentional tularemia in an alert health system; laboratory confirmation of agent could be delayed. Without treatment, the clinical course could progress to respiratory failure, shock, and death. Prompt treatment with streptomycin, gentamicin, doxycycline, or ciprofloxacin is recommended. Prophylactic use of doxycycline or ciprofloxacin may be useful in the early post exposure period."

JAMA. 2001;285:2763-2773

"The causative agent of tularemia, Francisella tularensis [a gram negative bacillus], is one of the most infectious pathogenic bacteria known, requiring inoculation or inhalation of as few as 10 organisms to cause disease. Humans become incidentally infected through diverse environmental exposures and can develop severe and sometimes fatal illness but do not transmit infection to others. The Working Group on Civilian Bio defense considers F tularensis to be a dangerous potential biological weapon because of its extreme infectivity, ease of dissemination, and substantial capacity to cause illness and death."

Routes of infection

Many routes are available for infection and the disease is readily transmitted directly between animals and humans by contact, or indirectly by tick or deer fly bites.

The most likely form of weaponized Tularemia is the inhaled variety which kills up to an estimated 35% of cases from pneumonia. For all modes of infection, ingestion, cutaneous, or insect bite, the death rate is only about 5% when left untreated.

Diagnostic Tests

Special culture media are necessary to isolate the organism. The bacillus is highly infectious and poses dangers to laboratory personnel.

The agglutination test is a reliable standard, and a safe method for making the diagnosis. Agglutination titers are negative for a week or two after onset of illness and reach a peak in 4-8 weeks that may persist for months or years.

Progression of disease

Disease onset usually occurs in 2-7 days of contact with an abrupt onset of fever, chills, local lymph node enlargement (with tenderness) and bacteremia. Fevers reaching 102 to 105F are common. Untreated, fever may persist for a month or more. Complications are rare.

Long-term immunity will follow recovery from tularemia, but reinfection, though rare, has been reported; New York Department of Health.

Treatment

Antibiotics such as doxycycline provide effective treatment.

Public Health Measures

Immunization is the best counter. Immunization always carries risks that might limit its general use.

A preventive vaccine is available for those at risk from the Center for Disease Control.

Links for more information:

Tularemia -- Center for Disease Control

Bioweapon -- Johns Hopkins Medicine

Biological Weapons -- From the Invention of State-Sponsored Terrorism to Contemporary Bioterrorism