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File: 123096_sep96_decls23_0048.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
Specific LabomtoEy Diagnosis: Ygrsinia @i @ be readily cultured from blood,
sputum, and bubo aspirates. Presumptive diagnosis cm be made by gram stain and (if typhoidal tularemia, a syndrome expected to have a caw-fatality rate which may be higher
available) immunofluorescent staining. Most naturally-mcurring s@ns of Y. produce than the 5-10% seen when disease is acquired naturally.
an 'Fl' antigen in-vivo, which can be detected in semm mmples by immunoasmys available
in field diagnostic laboratories. Clinical Features: A variety of clinical forms of tularemia are seen, depending open
the route of inoculation and vimlence of the strain. Since the infectious do@ is low (1-10
organisms by aerosol or intmdermal routes), ul@roglmdulu, typhoidal, or pharyngeal foriii@
C. 'HIERAPY could be seen. Ulceroglmdul@ tularemia generally occurs about 3 days after exposure
(range, 2-10 days), and manifests as regional lymphadenopathy, fever, chills, headache, and
Plague pneumonia is highly contagious. Patients should be managed in strict malaise, with or without a cutaneous ulcer. With typhoidal disease, the systemic clinical
ated. Uiitrntcd bubonic manifestations are similar to those seen in the ulceroglmdular form, but there is no skin
plague has a ca@-fatality rate commonly reported as around 50%; untreated primary lesion or adenopathy. Typhoidal tularemia is the form of dismw which occurs after
septicemic and pneumonic plague are invariably fatal. Streptomycin is the preferred inhalation of organisms; in this form, clinically and mdiologically evident pneumonia may bc
treatment, although tetracyclines, and chlommphenicol also are highly effective if begun significant. Three to five days following inhalation, the abrupt onset of fever, chills,
early (within 8-24 hours in pneumonic plague). Intramuscular streptomycin (I gm q 12 headache, myalgia, and prostration are seen, with a non-productive cough. Deposition of
hours), intravenous doxycyline (200 mg initially, followed by 100 mg q 12 hours), or organisms in the orophyarynx may also produce a pharynygeal form of tularemia, with
intravenous chlommphenicol (I gm q 6 hours) for 10-14 days are rmognized as effective ..ulcerogindulu" -type lesions Imalized to the throat.
against naturally occurring strains. Prophylaxis for contacts of pneumonic cases with
doxycyline (100 mg po bid for 10 days) is necessary to prevent secondary transmission. Diagnosis: The clinical presentation of tularemia may be severe, yet non
specific. Differential diagnoses include typhoidal syndromes (e.g., salmonella, rickettsia,
malaria) or pneumonic processes (e.g., plague, mycoplasma, SEB). A clue to the diagnosis
i of tularemia delivered as a biowufue weapon might be a large number of temporally
Vaccine: A licensed, formalin-killed Y. @s is vaccine is marketed in the U.S., and clustered patients presenting with similar systemic illnesses, a proportion of whom will have
has been utilized by U.S. military personnel for many years in highly plague-endemic areas. a non-productive pneumonia.
Vaccine effi@cy remains formally unproven, although anecdotal experience suggests it is
effective against, at least, bubonic disease. R@ctogenicity is moderately high, and immunity Specific Laboratory Diagnosis: Identification of organisms by staining ulcer fluids or
acquired after a 3-dose primary series (0,1, and 4-7 months) is sustained only with boosters sputum is generally not helpful. Routine culture is difficult, due to unusual growth
every 1-2 years. Live-attenuated vaccines produced in other countries are generally regarded requirements @d/or overgrowth of commensual bacteria. The diagnosis @ be established
as highly rmctogenic, with a potential for reversion. retrospectively by scrology.
C. TIIERAPY
is the treatment of choice.
Gentamicin also is effective (3-5 mg/kg/day parenterally for 10-14 days). Tetracycline and
TULAREMIA chloramphenicol treatment me effective as well, but are associated with a signific@t relapse
rate. Although laboratory-related infections with this organism are very common, human-to
A. CLINICAL SYNDROME human spread is unusual, and isolation is not required.
Tularemia is a zmnotic dismw caused by Fmcisella Ililarensis, a small, non spore- D. PROPIIYLAXIS
forming gram negative bacillus. Hum@s acquire the disease under natural conditions
through inoculation of skin or mucous membranes with blood or tissue fluids of infected A live-attenuated tularemia vaccine is available as an invesdgadonal new dmg. This
mimals, or bites of infected dmrflies, mosquitoes, or ticks. Less commonly, inhalation of vaccine has been administered to more than 5,000 persons without significant adverse
contaminated dusts or ingestion of contaminated foods or water may produce clinical disease. reactions, and is of proven effectiveness in preventing labomtory-acquired typhoidal
A biological warfare attack with F, tuluensis delivered by aerosol would primarily cause tularemia.
The use of antibiotics for prophylaxis against tularemia is controversial.
86
87
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996