Tularemia Treated with Artificial Fever Therapy

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When tularemia was first discovered, it appeared as though the occurrence of the infection was limited entirely to the Western part of the United States, but today it is found throughout the country. The causative organism is the bacterium tularense and the infection is non-contagious. It may be transmitted by any number of insects, but the usual source is the ordinary cottontail rabbit. An increased number of patients with this disease is seen during the hunting season because the infection is obtained from handling or skinning infected animals. This also explains the common site of the primary ulcer which is located most frequently on the fingers or the hand.

Netherton1 described the primary lesion. The ulcer is granulomatous and the base shows a rich cellular infiltration with mononuclear cells predominating and a giant cell is noted occasionally. Marked hyperplasia of the endothelium of the capillaries is produced and in some areas the lumen is almost obliterated. Perivascular lymphatic infiltration at the margin of the lesion is especially noticeable.

The incubation period ranges from one to six days. The onset is usually sudden and is characterized by chills, headache, muscular pains throughout the entire body, especially in the muscles of the thighs and back, vomiting, prostration, and elevation of the temperature. The temperature usually ranges between 101° and 104° F. and continues to be high with some remission during the morning.

Tularemia is usually classified into four distinct clinical types: (1) ulceroglandular, (2) oculoglandular, (3) glandular, and (4) typhoid.

The ulceroglandular. . .



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