Francisella

CASE 1

• A 45 year old farmer in middle North America develops a spontaneous ulcer on his thumb. There has been no trauma. He is an avid hunter, and he recently shot a rabbit in his fields and brought the carcass to his house to skin it for the fur pelt and the meat.

• The patient is not febrile, but is physician is concerned that he may have tularemia and begins therapy for this infection immediately.

• A culture of the wound and of the patient's blood are both negative after two weeks. However, 2 months after the onset of the ulcer, when the patient's ulcer is nearly completely healed, an antibody test for Francisella tularensis antibodies is positive, confirming that this was the cause.

Questions:

1. How did this patient acquire tularemia?
2. How else can tularemia be acquired?
3. How does the portal of entry of this organism into the body affect the presentation of the disease?
4. What happens if a significant aerosol of the organism is inhaled?
5. Where does tularemia occur? Is it a problem in Ghana?
6. How was this patient treated?