A 5-year-old girl presented to the pediatric emergency department with a 4-week history of painful swelling on both sides of her lower abdomen. Pets that she had regular contact with included a cat and a dog. Six weeks before presentation, her parents had noticed a tick buried in her umbilicus and had removed it with tweezers. Five days later, the patient had fever, loss of appetite, fatigue, and redness around the umbilicus (Panel A). These symptoms abated after 4 days. At the time of this presentation, examination showed marked inguinal lymphadenopathy on both sides (Panel B). Treatment with oral ciprofloxacin was initiated for suspected ulceroglandular tularemia. Serologic testing supported the diagnosis; the Francisella tularensis antibody titer was 1:1280. Two weeks after the completion of treatment, there was a reduction in the lymphadenopathy. After an additional 2 weeks, the swelling had completely resolved.
- https://madisonarealymesupportgroup.com/2019/08/23/ticks-are-one-way-tularemia-can-be-spread-rabbits-are-another/Transmission: Transmission can occur through the skin or mucous membranes when handling infected animals as well as through tick bite, contact with fluids from infected deer flies, mosquitoes or ticks, handling or eating undercooked rabbit, drinking contaminated water, inhaling dust from contaminated soil, and handling contaminated pelts or paws of animals. It can also be inhaled from infected hay, grain, or soil. Dr. Lepore had patients who contracted it from their pet dog who shook rain water on them after chewing on a dead rabbit, as well as from folks eating road kill, a person who held sick animals, and a gentleman who slept with his pet bunny.
Another reminder – don’t sleep with pets!
According to DHS, tularemia in Wisconsin is rare, with less than one case per year since 1980. In 2016, a tularemia alert was given for La Crosse due to the death of three infected cats. And according to this report, while rabbits are the main source of transmission in Wisconsin, aquatic mammals (muskrat, beaver), woodticks, upland game birds: (partridge, pheasant, prairie chicken), cats, squirrels, deer-fly bites, skunks horses, sick dogs which killed rabbits, foxes, possible skunk, mink, muskrat or raccoon are also responsible. One case was recorded from exposure to a contaminated stream. It’s been called “Deer-fly Fever.”