Tularemia of the head and neck: a possible sign of bioterrorism.
Recent bioterror attacks and other world events have focused the medical community's attention on agents that might be used in biological warfare. One of these potential biological weapons is Francisella tularensis, a gramnegative coccobacillus that is one of the most infectious bacteria known. F tularensis can cause severe, even fatal, systemic tularemia. Under normal circumstances, F tularensis is transmitted by infected ticks, insects, and other animals. As a weapon of terrorism, the bacterium would likely be disseminated as an aerosol and contracted by inhalation. Because many cases of tularemia are characterized by head and neck symptoms, otolaryngologists should be familiar with the diagnosis and management of this disease. In this article, we describe a case of zoonotic tularemia that manifested as a neck mass, and we review the pathophysiology, diagnosis, and treatment of tularemia. We also summarize what is known about its potential as a biological weapon.
Department of Otolaryngology-Head and Neck Surgery, University of California, 400 Parnassus Ave., Suite A717, San Francisco, CA 94143, USA. hstupak@itsa.ucsf.edu
Howard D
HD
Stupak
Michael C
MC
Scheuller
David N
DN
Schindler
David E
DE
Ellison
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D023482:Bioterrorism; D002939:Ciprofloxacin / Q000627:therapeutic use; D005604:Francisella tularensis / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D009333:Neck; D014406:Tularemia / Q000188:drug therapy / Q000382:microbiology*
D000890:Anti-Infective Agents; D002939:Ciprofloxacin