Diagnosis, treatment and prevention of tularemia

The diagnosis. Given the difficulty of clinical recognition of tularemia should be used complex methods of research (epidemiological, clinical and laboratory), and intracutaneous test with tulainkom.
The differential diagnosis should be carried out with the plague, anthrax, tuberculosis, influenza, banal pneumonia, infectious mononucleosis, typhus and abdominal by fever, sepsis, diphtheria, banal lymphadenitis and other
Forecast in most cases, favorable; the mortality rate below 1%.
Laboratory diagnostics. For the diagnosis of tularemia apply allergic diagnostic test with tulainkom. Talaren in the amount of 0.1 ml enter strictly intradermally on the Palmar side of the forearm. In the positive cases within 24 to 48 hours. in the injection appear redness and swelling size of 1-3 cm in diameter, disappearing in the following days. The response becomes positive with 3-5-th day of illness and lasts for many years.
The agglutination reaction with tularemia the diagnosticum is specific and common method serological diagnosis. It becomes positive in titer 1 : 100 and above with a 2-3rd week of illness. 8 weeks agglutination titer declining. Both responses are specific (but not in vaccinated).
Applied also RAC, opsona-phagocytic reactions, Treponema pallidum haemagglutination assay. When there are special laboratories in the first 10-12 days of illness perhaps the selection of bacteria cultures biological method. The contents of skin ulcers, bubo, blood of the patient is injected subcutaneously or intraperitoneally Guinea pigs, white mice. In case of death of the animal from its bodies emit culture of the pathogen. Sowing produce rolled yolk environment. In the discharge of skin ulcers and punctate from buboes pathogen occurs within 3 weeks from the onset of the disease.
Treatment of tularemia. Apply streptomycin intramuscularly from 500 000 to 1 000 000 IU a day for 8-10 days. Other antibiotics - levomitsetin, biomitsin, terramycin - appointed interior in normal doses, but the result of their actions weaker.
The vaccine therapy (intravenous in 1-5-10-15 million microbial cells for injection at intervals 5-6 days) apply in the case of antibiotic-resistant strains. The dose is increased, if the previous infusion was low overall response with temperature higher than 38 degrees. The course - 6-8-12 injections. On introduction of the vaccine possible common reaction with fever, a temperature of 38 degrees and above, abundant perspiration and temporary exacerbation of the disease. In persistent cases of tularemia rational combination of therapeutic vaccines with antibiotic therapy. In ulcerative-bubonic and bubonic forms locally apply compresses with Vishnevsky ointment, sulfur , mercury, etc. In pussy softening make the cut buboes. Appoint cardio-vascular equipment, a Dimedrol, pipolfen.
Prevention of tularemia. Persons conducting catching rodents (water rat, musk-rat and others), removal and processing of hides, it is necessary to immunize. You should wear protective clothing: canvas overalls, rubber aprons, gloves, glasses, cans, cotton-gauze respirators. In the case of the epidemic tularemia the hares and hunting them is prohibited. Strict veterinary supervision in rabbit farms. In natural foci of tularemia - daily disinfection of drinking and service water, prohibition swimming in open water, pest activities, protecting people from stings of blood-sucking vectors (refill service, safety nets Pavlovsky, sasaciloa, repellents and other). Sanitary equipment water supply (sealing, unavailability of wells for rodents). Harvest, proper storage of threshed grain reduce the number of rodents.
Specific prevention tularemia is dry live vaccine cutaneous method. In the course of vaccination scratches appear vesicles that to the 15-th day covered with a crust. After vaccination may increase regional lymph nodes, fever. Active immunity is maintained for at least 5 years. Vaccination is subjected to the entire population (starting from 4 years old)living on the territory of natural foci. Individuals who have ill with tularemia, exempt from vaccinations.