[Tularemia as a potential weapon of bioterrorists]

This paper addresses the issue of using airborne tularemia as a potential biological weapon of terrorists. Because of its extreme infectivity, easy dissemination and substantial pathogenic ability, it may become a dangerous biological agent. An outbreak of acute febrile illness with pneumonia, pleuritis and hilar lymphadenitis in urban healthy populations, regardless of age and gender, should suggest an action of terrorism. The presumptive diagnosis should be based on epidemiological and clinical findings as the final microbiological confirmation may take several weeks. The treatment with aminoglicosides or alternatively doxycycline and ciprofloxacin administered parenterally is recommended. In a mass casualty situation, oral doxycycline and ciprofloxacin are the preferred drugs. Vaccination is recommended only in the laboratory personnel working routinely with Francisella tularensis. Isolation and special precautions are not necessary because the illness is not transmitted from one person to another.