Eurosurveillance, Volume
9, Issue
12,
01 December 2004
Guidelines
Bichat guidelines for the clinical management of tularaemia and bioterrorism-related tularaemia
P Bossi1, A Tegnell2, A Baka3, F van Loock2, A Werner2, J Hendriks2, Heinrich Maidhof2, Georgios Gouvras2
Citation style for this article: Bossi P, Tegnell A, Baka A, van Loock F, Werner A, Hendriks J, Maidhof H, Gouvras G. Bichat guidelines for the clinical management of tularaemia and bioterrorism-related tularaemia. Euro Surveill. 2004;9(12):pii=503. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=503
Date of submission:
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Philippe Bossi*, Anders Tegnell, Agoritsa Baka, Frank Van Loock, Jan
Hendriks, Albrecht Werner, Heinrich Maidhof, Georgios Gouvras
Task Force on Biological and Chemical Agent Threats, Public Health Directorate,
European Commission, Luxembourg
*Corresponding author: P. Bossi, Pitié-Salpêtrière
Hospital, Paris, France, email: philippe.bossi@psl.ap-hop-paris.fr
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Francisella tularensis is
one of the most infectious pathogenic bacteria known, requiring inoculation
or inhalation of as few as 10 organisms to initiate human infection.
Inhalational tularaemia following intentional release of a virulent strain
of F. tularensis would have great impact and cause
high morbidity and mortality. Another route of contamination in a deliberate
release could be contamination of water.
Seven clinical forms, according to route of inoculation (skin, mucous membranes,
gastrointestinal tract, eyes, respiratory tract), dose of the inoculum
and virulence of the organism (types A or B) are identified. The pneumonic
form of the disease is the most likely form of the disease should this
bacterium be used as a bioterrorism agent. Streptomycin and gentamicin
are currently considered the treatment of choice for tularemia. Quinolone
is an effective alternative drug. No isolation measures for patients with
pneumonia are necessary. Streptomycin, gentamicin, doxycycline or ciprofloxacin
are recommended for post-exposure prophylaxis.
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