title: [Tularemia as a biological weapon].
abstract: Tularemia is a zoonosis, caused by the Gram-negative bacterium, Francisella tularensis. The organism penetrates the human body through interrupted skin or mucous membranes, via animal contact or bites from ticks, deer-flies and mosquitoes. Contaminated aerosol and water are alternative modes of transmitting the germ through the respiratory and alimentary tracks. In light of its high infectivity in aerosol and its offensive occupation in the past, tularemia may appear in a biological warfare context. After an incubation period of 3-5 days, the disease begins with systemic symptoms, which abate, leaving a clinical picture, dominated by one of the listed patterns: ulceroglandular, typhoidal, glandular, occuloglandular, pharyngeal or pneumonic. Diagnosis and identification of the bacterium is difficult and even hazardous. Most diagnoses are established by serology which is positive in 50-70% of the patients after 2 weeks of illness, and in most of them by 4-8 weeks. The treatment of choice is streptomycin intra-muscular, or gentamicin intra-venous for 10-14 days. Prophylaxis may be achieved by tetracycline treatment, beginning up to 24 hours from exposure, for 2 weeks, or by a live attenuated, investigational vaccine. Nevertheless, post-exposure, or even better so, pre-exposure intervention is the most effective way of preventing the devastating results of the attack.
authors.affiliation: Genetic Unit, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University.
authors.forename: Lior
authors.initials: L
authors.lastname: Katz
authors.forename: Avi
authors.initials: A
authors.lastname: Orr-Urteger
authors.forename: Baruch
authors.initials: B
authors.lastname: Brenner
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
mesh_terms: D000818:Animals; D001694:Biological Warfare / Q000517:prevention & control*; D023482:Bioterrorism / Q000517:prevention & control*; D009033:Culicidae; D003937:Diagnosis, Differential; D004175:Diptera; D006801:Humans; D007299:Insect Bites and Stings; D013987:Ticks; D014406:Tularemia / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*