Rabbit Talk In Ohio

Have you every stopped to consider that the cute little fluffy animal with the

cottontail could be an impending killer? Wild rabbits as well as domestic rabbits can

carry a potentially deadly disease called Tularemia. This disease is mostly carried by a

wild rabbit, but can be transferred to your domestic rabbit and you but various different

ways. Tularemia, also known as "rabbit fever," is a disease caused by the bacterium

Francisella tularensis. Tularemia is typically found in animals, especially rodents,

rabbits, and hares. Tularemia is usually a rural disease and has been reported in all U.S.

states except Hawaii (CDC, 2008) This~ paper will be an gathering of information on who

can get Tularemia, what to look for and how to prevent and protect against it.

Now that we know how Tularemia is defined, who gets this disease and how is it

transferred from animal to person. Tularemia is generally found in wild rabbits and

rodents. A fly, mosquito, tick or flea can transfer the bacterial disease from the wild

rabbit to your domestic animals or to you. These insects biting your rabbits, domestic

pets or you transmit it. The bacteria are then introduced into the host body and the

disease is contracted. The following is the different ways humans can contract this

disease. The only know fact that is known is that Tularemia cannot be transferred from

person to person.

Though insect bites is the most common way for household animals to get Tularemia, humans can get it in various ways and
it causes different problems.

Handling of infectious animal tissues or fluids

Ingestion of contaminated food that is not properly cooked or in water

Possibly direct contact with contaminated soil or water

Inhalation of infectious aerosols, including dust from contaminated hay and aerosols generated by lawn mowing and brush
cutting

Exposure in the laboratory setting (eg, inhalation of infectious aerosols, handling cultures or other infectious materials,
accidental percutaneous exposure) (CIDRAP, 2008)

Now that is it acknowledged just how the disease is contracted, what are the signs and

symptoms to look for? In rabbits and animals the only way to tell if the animal is

carrying the disease is that they become sluggish and lethargic. There is also the

appearance of an ulcer on the skin that just will not heal. A Necropsy on the animal after

death will confirm the disease.

The South Dakota State University Veterinarians found this upon a dead wild

rabbit, "Lesions included enlarged spleen and white pinpoint spots on the liver.

Inflammation of the liver, intestine, and lung were found microscopically. F. tularensis

was isolated from lung, liver, kidney, and spleen." (Daly, 2007)

With animals there is not much difference in contracting the disease, in humans

however there are different names for the various ways of contracting the disease.

Pneumonic Tularemia-- Organisms enter the lungs either through inhalation of

infectious aerosols or through hematogenous spread. The following is a list of

indicators.

Incubation period is 3-5 days

Incubation period is 3-5 days.

Patients often present with community-acquired atypical pneumonia not responsive to conventional antibiotic therapy

Predominant symptoms include abrupt onset of fever, nonproductive cough, myalgias (particularly low back)

Nausea, vomiting, diarrhea may occur

Illness may be rapidly progressive and severe or may be indolent with progressive weakness and weight loss over several
weeks to months

Skin lesions may be noted (erythema nodosum; erythema multiforme-like exanthem on hands, arms, or legs; maculopapular
rash; acneiform lesions; urticaria)

Lung abscesses or cavitary lesions

Adult respiratory distress syndrome

Fibrosis and calcifications in affected lung areas or pleura as illness resolves

Granulomatous pleuritis (which may resemble tuberculosis)

Empyema with bronchopleural fistula

Involvement of other organs through hematogenous spread (Producing blood.
Originating in or spread by the blood)

Sepsis syndrome (systemic inflammatory condition associated with infection)

Meningitis

Pericarditis

Illness may be debilitating, with full recovery taking several months; relapses have been reported with use of broad-spectrum
antibiotics. (University of Minnesota, 2008)

Oculoglandular Tularemia-- Organisms gain entry via the conjunctiva.

Incubation period 3-5 days

Multiple painful yellow conjunctiva nodules

Tender regional lymphadenopathy. Fever

Constitutional symptoms (chills, malaise, myalgias, arthralgias, headache, anorexia)

Other skin lesions may be noted (erythema nodosum; erythema multiforme-like exanthem on hands, arms, or legs;
maculopapular rash, acneiform lesions, urticaria)

Suppuration of involved lymph nodes

Secondary pneumonia (31% of patients with ulcer glandular disease in one case series and 17% of patients with ulcer glandular
or glandular disease in another)

Involvement of other organs (via hematogenous spread) .:. Sepsis syndrome

Illness may be debilitating, with full recovery taking several months

Lymphadenopathy may persist for months (University of Minnesota, 2008)

• Oropharyngeal Tularemia- Organisms enter the mucous membrane of the

oropharynx following ingestion or inhalation of organisms. Exudative pharyngitis

or tonsillitis usually occurs, and ulcers may develop. Organisms spread to the

cervical lymph nodes where necrosis and suppuration may occur.

Constitutional symptoms (chills, malaise, myalgias, arthralgias).Exudative pharyngitis or tonsillitis

Fever

Ulcerations of pharynx, tonsils, soft palate. Stomatitis (less common)

Conjunctival ulcers

Chemosis

Periorbital and facial edema around affected eye

Extremely tender regional adenopathy involving preauricular, submandibular, or cervical lymph nodes; edema around affected
nodes may be present

Patients may present with Parinaud's syndrome (unilateral granulomatous conjunctivitis and enlarged preauricular lymph nodes)

Constitutional symptoms (fever, chills, malaise, anorexia)

History of minor eye trauma, swimming in potentially contaminated water (possibly a risk factor), or tick exposure may be present
with naturally acquired infection

Suppuration of affected lymph nodes. Sepsis syndrome

Involvement of other organs (through hematogenous spread) (University of Minnesota, 2008)

Glandular and Ulcer glandular Tularemia--Local painful cutaneous lesion at

site of inoculation (papule that ulcerates within a few days) in ulcer glandular form;

no cutaneous lesion in glandular form

1 Tender regional lymphadenopathy

2 Fever

3 Constitutional symptoms (chills, malaise, myalgias, arthralgias, headache, anorexia)

4 Other skin lesions may be noted (erythema nodosum; erythema multiforme-Iike exanthem on hands, arms, or legs; maculopapular
rash, acneiform lesions, urticaria)

5 Local painful cutaneous lesion at site of inoculation (papule that ulcerates within a few days) in ulceroglandular form; no cutaneous
lesion in glandular form

6 May see pharyngeal membrane suggestive of diphtheria (membrane associated with tularemia does not bleed if removed, unlike
diphtheria where removal of membrane reveals bleeding submucosa)

7 Cervical or retropharyngeal adenopathy (cervical nodes tender to palpation)

1 Concomitant pneumonia often present

2 Patients may present with dental abscesses

3 Sepsis syndrome

4 Suppuration of involved lymph nodes

5 Involvement of other organs (via hematogenous spread)

6 Illness may be debilitating, with full recovery taking several months (University of Minnesota, 2008)

Typhoidal Tularemia- involves a systemic illness without anatomic localization of

infection. Organisms enter the bloodstream through breaks in the skin or through

mucous membranes and may affect the lungs and reticuloendothelial organs (ie,

lymph nodes, liver, spleen, bone marrow). Necrotic foci can occur in any involved

organ, and caseating granulomas may develop. Sepsis may occur, leading to shock,

organ system failure, adult respiratory distress syndrome, and disseminated

intravascular coagulation.

1 Fever

2 Constitutional symptoms (chills, malaise, weakness, myalgias, arthralgias)

3 . Prostration

4 Dehydration

5 Gastrointestinal symptoms (watery, no bloody diarrhea; vomiting; abdominal pain)

6 Skin lesions may be noted (erythema nodosum; erythema multiformelike exanthem on hands, arms, or legs; maculopapular rash;
acneiform lesions; urticaria)

7 Secondary pneumonia (83% of patients with typhoidal disease in one case series:j: and 50% in anothers)

8 Involvement of other organs via hematogenous spread (eg, meningitis, hepatitis and jaundice, splenic rupture, encephalitis, pericarditis,
peritonitis, osteomyelitis)

9 Sepsis syndrome

10 Rhabdomyolysis

11 Renal failure

12 Illness may be debilitating, with full recovery taking several months, relapses have been reported with use of broad-spectrum antibiotics
(University of Minnesota, 2008)

Now we have found the many complications that Tularemia can cause a

human, lets see how it is treated. There is no cure for animals that contract this

disease. Humans on the other hand can take a serious of strong antibiotics if the

infection is caught in the early stages. It is important to let your doctor know if you

raise rabbits, hunt rabbits or eat them. A serious of tests can be studied if the

doctor suspects that Tularemia is the cause.

Treatment with antibiotics for a period for 10-14 days or more after the

exposure may be recommended. The antibiotics that are used are streptomycin and

gentamicin. The laboratory will test the blood for an organism, or lesions on the body.

Local and state health departments should be notified immediately so an investigation

and infection control activities can begin. (CDC, 200B)

There are many ways to avoid having your animals and yourself. Sanitation of your rabbitry

and yard is the most important. Wash hands after touching blood, body fluids, secretions, excretions,

and contaminated items, whether or not gloves are worn. Wear gloves when touching blood,

body fluids, secretions, excretions, and contaminated items; put on clean gloves just before touching

mucous membranes and nonintact skin. Change gloves between tasks and procedures on the same

patient after contact with material that may contain a high concentration of microorganisms. Remove

gloves promptly after use, before touching noncontaminated items and environmental surfaces, and

before going to another patient, and wash hands immediately to avoid transfer of microorganisms to

other patients or environments. Do not use rabbit dropping in your garden if you think there is a chance

for contamination. Fly control is also essential to keep them from spreading Tularemia and other problem

diseases.

Commercially available bleach or a 1: 1 0 dilution of household bleach and water is considered adequate

for cleaning contaminated surfaces. After 10 minutes, a 70% solution of alcohol can be used to further clean

the area and reduce the corrosive action of the bleach. Following direct exposure to powder or liquid aerosols

containing F tularensis, body surfaces and clothing should be washed with soap and water. The risk of

environmental contamination following an intentional release of F tularensis is expected to be minimal and no

special environmental decontamination procedures are recommended. (University of Minnesota, 2008)

It is important to know all the facts and information about this disease. Not many people know about Tularemia.

With its limited exposure, it is not an immediate threat. If you find that you are sick and can't seem to get rid of the

illness, then it may be imperative to have your doctor drawl blood. Its essential to catch it early so that you do not

suffer further conditions. I lost a wonderful Great, Great Uncle because it was not something the doctor would look for.

If it had been more widely known and even one person in his family was acquainted with the symptoms, then he wouldn't

have suffered for so long. Awareness of the lesser-known things will some day save someone or their family.

REFERENCES

"Cause of rabbit disease outbreak confirmed."

http://www.avma.gov/onlnews/javma/aug05/050801ff.asp, (May, 2008).

Daly, Russ and Miskimins, Dale. "Tularemia in Animals in South Dakota."

http://vetsci.sdstate.edulvetextltularemia.htm (May, 2008).

"Frequently asked questions (FAQ) about Tularemia." Center for Disease Control

and Prevention (CDC). http://www.bt.cdc.gov/agentltularemia/fag.asp, (June, 2008).

"Knowing local conditions can help in spotting Tularemia." http://www.cidrap.umn.edulcidrap/contentlbtltularemina/news (May, 2008).

"Tularemia" http://www.mayoclinic.comihealthitularemia/DS000714 (June, 2008).

"Tularemia" http://www.nlm.nih.gov/medlineplus/ency/article/000856.htm (June, 2008).

"Tularemia: Current, Comprehensive information on pathogenesis, microbiology epidemiology, diagnosis, treatment and

prophylaxis." Academic Health Center, University of Minnesota.

http://cidrap. umn.deulcidrap/contentlbtltularemia/biofacts/tularemiafactsheet.html

(May, 2008).
"Tularemia Facts." http://www.avma.org/public health/biosecurity/tularemia facts.asp (June, 2008).