Tularaemia: What is it, and why should we care?

What is tularemia?

Tularaemia is an infectious disease caused by a bacterium called Francisella tularensis; Francisella tularensis is mostly found in the Northern Hemisphere, particularly in North America, Europe and Asia. Furthermore, tularaemia can be found in tropical zones; however, this is rare. Out of the locations, Francisella tularensis found in North America is deemed to be the most harmful.

So, where can you contract this terrible infection? It is commonly found in rabbits and rodents, and is transmitted to humans through bites from infected ticks and mosquitoes and direct contact with infected animal tissue. Francisella tularensis bacteria can enter the body through cuts in the skin or through consumption of contaminated water. Furthermore, Francisella tularensis is airborne, and you only need to inhale a very small amount to become infected.¹

Why are tularaemia and francisella tularensis important?

Tularaemia, and especially Francisella tularensis, are important because it causes serious illness if you become infected. Education could help to reduce your risk of becoming exposed to tularaemia; however, it does not eliminate the risk. Furthermore, with no vaccines available, tularaemia could seriously impact your health.

Spotting tularemia symptoms

What to look out for

Multiple areas of your body can become infected. Let's go through each area and the symptoms that you are to expect:²

Ulceroglandular tularaemia is the most common form and is characterised by painful skin ulcers in the area where the bacteria entered your body. The common areas for these ulcers are on the fingers, armpits, legs, arms, and groin.

Glandular tularaemia is very similar to the ulceroglandular tularaemia; however, you will not develop ulcers. Instead, your lymph nodes will become swollen, tender and painful.

Oculoglandular tularaemia happens when you touch your eye after your hands have come into direct contact with the bacteria, and then the infection will infect your eye itself. Your eye would likely become red and swollen, and feel irritated. Furthermore, the lymph nodes near your ears might often become swollen.

Oropharyngeal tularaemia will present as a sore throat, swollen neck glands, and potential mouth ulcers from ingesting contaminated food or water.

Pneumonic tularaemia is the most serious form of the infection caused by Francisella tularensis. Francisella tularensis affects the lungs and will cause chest pain, a wet cough, and can make breathing difficult; this can happen when your tularaemia spreads from other areas of your body.

Typhoid tularaemia does not cause specific symptoms in one area of the body. Instead, you will get general symptoms, including fever and fatigue.

Preparing the community: what we can do 

Share the word

Educating others on the infection is very effective for preventing further infection. Information leaflets can be given out in areas including libraries, hospitals, and your GP or doctor's surgery. Key information would involve preventative actions, especially for those most at risk. Outdoor workers can wear insect repellent and gloves to prevent cutting their hands, and avoid areas where there is contaminated water. If you are involved in communities related to hunting, camping, and wilderness exploring, then you must be aware of the areas where you are most at risk.³

Keep an eye out

Teams can begin to build a database that offers information, such as areas prone to tularaemia infections and the locations of the most serious. Databases will allow other preventative strategies to develop, such as education and infection control. Monitoring where tularaemia is infecting people the most will allow the potential for health agencies to discover potential outbreaks before they become a wide-scale issue, which will give a chance for healthcare responses.

Train up health workers

Making sure healthcare workers, including nurses and doctors, will be a step in saving those infected with tularaemia. There are no specific treatments available; however, it is advised to give an antibiotic called gentamicin. There are other medications if you have a less serious infection, such as the less harmful strains found in Europe.³

Responding to an outbreak: take action

Quick action is key

If there is an outbreak in your community, then there are a number of actions you can take to effectively minimise the spread of tularaemia. These include:⁴

• Avoid crowds
• Keep hands clean, washing them under warm water for 30 seconds and drying them with hand towels (avoid hand dryers); this is especially important before eating and touching animals
• Wear medical-grade facemasks
• Clean your surroundings with detergents and disinfectants, pay close attention to high-contact surface areas, such as door handles, remotes, light switches, and phones
• Stay in well-ventilated areas. If this is inside, then keep doors and windows open ajar

Community support

Keeping community trust is a must to get those at risk to take preventative action. The spread of misinformation is inevitable, and so maintaining trust as an organisation or an individual would improve health outcomes; demonstrating you understand those most at risk will allow the most vulnerable to be heard.

Data to create databases can be collected by reporting all the cases you are aware of to the appropriate health bodies; this alone will improve infection surveillance of tularaemia. From this, you and others can learn from previous cases to prevent future cases from arising.⁵

Building a report for tularaemia cases is not just relevant to this infection. Many different bacterial infections spread similarly and cause similar symptoms. Looking at other infections caught from animals (zoonotic diseases) could prevent outbreaks of other infections. Some examples of infections spread similarly to tularaemia are:

• Brucellosis
• Plague
• Q fever

Follow-up

Following up on the evidence you have collected and the education you have received is critical in the prevention of future tularaemia infections.

Creating those educational programmes, informative leaflets, and spreading the work with trust and clarity are all steps you can take in preventing tularaemia; this could help maintain a healthier environment for those most vulnerable to Francisella tularensis exposure.

Summary

Tularaemia is a bacterial infection caused by Francisella tularensis, which is mostly found in North America, Europe and Asia. The worst cases of tularaemia are understood to occur mostly in the North American strain. Tularaemia is contracted through bites from mosquitoes and ticks that are carrying the bacteria. Additionally, Francisella tularensis can be caught if you come into direct contact with infected animal tissue or if you ingest contaminated water. Airborne Francisella tularensis is more challenging to avoid and only takes a very small amount to breathe in for you to become infected.

Tularaemia can cause serious illness, and there are no vaccinations available to prevent the infection itself. Common symptoms depend on where in the body the infection has taken place. The most common form is ulceroglandular tularaemia, which causes painful skin ulcers and swollen lymph nodes. Other forms of the infection will not present as ulcers; for example, pneumonic tularaemia (the most serious of the tularaemia infections) will present like a chest infection, with a wet cough and difficulty breathing.

There are ways to prevent infection, including the use of insect repellent, wearing gloves, and avoiding contaminated water. If there were to be an outbreak of infections near you, then it is important to follow guidelines involving disinfection, avoiding crowds, and maintaining hygiene. These steps will support vulnerable communities who are most at risk of tularaemia outbreaks.