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Two cases of tularemia in hunters from rural Newfoundland
Andrew P Sullivan1, Catherine Nicholson1, David J Bradbury-Squires2
1Discipline of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland.
Background:
Tularemia is a rare zoonosis caused by Francisella tularensis, a small gram-negative intracellular coccobacillus. Transmission occurs through direct contact with small mammals such as hares and rabbits, exposure to ticks, or ingestion or inhalation of aerosolized particles. It is a highly variable disease with six subtypes based on clinical features. Tularemia is a very rare disease in Canada, with only 0.01 cases per 100,000 people reported in 2017.
Methods:
In this case report, we describe two cases of tularemia affecting hunters from rural Newfoundland and Labrador.
Results:
The first case describes a patient with glandular tularemia diagnosed with serology; the second describes a patient with typhoidal tularemia diagnosed on blood culture. Both patients recovered after treatment with gentamicin.
Discussion:
These cases highlight the importance of eliciting a careful social history from patients presenting with an unexplained febrile illness. Tularemia should be considered in the differential diagnosis of fever after hunting in rural areas.
