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Tularemia polmonare. Pasquale Urbano. Tularemia. Incubazione: 2-10 gg Prodromi: Febbre, cefalea, brividi, mialgie, tosse, nausea, vomito, diarrea Può presentarsi come polmonite Diagnosi Laboratorio: Coltura/Batterioscopia (Gram) da sangue, escreato, linfonodo

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Tularemia polmonare

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Tularemia polmonare l.jpg

Tularemia polmonare

Pasquale Urbano


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Tularemia

  • Incubazione: 2-10 gg

  • Prodromi:

    • Febbre, cefalea, brividi, mialgie, tosse, nausea, vomito, diarrea

    • Può presentarsi come polmonite

  • Diagnosi

    • Laboratorio: Coltura/Batterioscopia (Gram) da sangue, escreato, linfonodo

    • La coltura è esigente, e comporta rischi di Tularemia per il personale di laboratorio


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Outbreak

Taglio dei prati e dei cespugli identificati come fattori di rischio, in zona endozootica

Grosso allarme


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Batterioscopia


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Isolamento

  • Richiede BSL 3

    • Infezioni di laboratorio


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Cautela!

  • When F. tularensis is presumptively identified in a routine BSL-2 clinical laboratory (level A), specimens should be forwarded to a BSL-3 laboratory (level B) (eg, a state public health laboratory) for confirmation of agent and other studies, such as antimicrobial susceptibility testing

Vedi: incidente di laboratorio


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Tularemia polmonare

Isolamento

Standard; non contagiosa

Non trasmissione interumana

Trattamento

Streptomicina, gentamicina, o doxiciclina

Se esposti: osservazione per 7 gg,; trattare se viene la febbre

Vaccino: sperimentale

Letalità 30% senza trattamento; < 10% nei trattati


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Vaccino per tularemia

F. tularensis is designated as a category A bioterrorism agent. At present, no licensed tularemia vaccine is available in the USA. However, the LVS vaccine (live vaccine strain) is available to military personnel under an investigational new drug protocol held by the US Army Medical Research Institute of Infectious Diseases (4). It is administered via scarification using multiple punctures of a bifurcated needle. LVS is derived from strain 15 developed in the former USSR and was obtained by the US military in 1956 (5). It is not well-standardized and contains 2 phenotypes of F. tularensis, only one of which seems to be immunogenic (6). However, in studies published in 1977, the vaccine was shown to significantly reduce the incidence of typhoidal tularemia in US government laboratory workers from 5.7 to 0.27 cases per at-risk employee years (7). It did not reduce the incidence of the ulceroglandular form, but the disease in vaccinees was reported to be milder. I am not aware whether the vaccine is effective if given postexposure.


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Working Group Consensus Contained Casualty Recommended Therapy

  • Adults

  • Preferred choices

    • Streptomycin, 1 g IM twice daily

    • Gentamicin, 5 mg/kg IM or IV once daily

  • Alternative choices

    • Doxycycline, 100 mg IV twice daily

    • Chloramphenicol, 15 mg/kg IV 4 times daily

    • Ciprofloxacin, 400 mg IV twice daily


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Working Group Consensus Contained Casualty Recommended Therapy

  • Children

  • Preferred choices

    • Streptomycin, 15 mg/kg IM twice daily (should not exceed 2 g/d)

    • Gentamicin, 2.5 mg/kg IM or IV 3 times daily

  • Alternative choices

    • Doxycycline; if weight >45 kg, 100 mg IV twice daily; if weight <45 kg, give 2.2 mg/kg IV twice daily

    • Chloramphenicol, 15 mg/kg IV 4 times daily

    • Ciprofloxacin, 15 mg/kg IV twice daily


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Working Group Consensus Contained Casualty Recommended Therapy

  • Pregnant Women

  • Preferred choices

    • Gentamicin, 5 mg/kg IM or IV once daily

    • Streptomycin, 1 g IM twice daily

  • Alternative choices

    • Doxycycline, 100 mg IV twice daily

    • Ciprofloxacin, 400 mg IV twice daily


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Working Group ConsensusMass Casualty Recommended Therapy

Adults

  • Preferred choices

    • Doxycycline, 100 mg orally twice daily

    • Ciprofloxacin, 500 mg orally twice daily

  • Children

  • Preferred choices

    • Doxycycline; if <45 kg, give 100 mg orally twice daily; if >45 kg, give 2.2 mg/kg orally twice daily

    • Ciprofloxacin, 15 mg/kg orally twice daily

  • Pregnant Women

  • Preferred choices

    • Ciprofloxacin, 500 mg orally twice daily

    • Doxycycline, 100 mg orally twice daily


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Incognite

Non essendo da escludere che per usi aggressivi siano impiegati ceppi manipolati geneticamente, magari resistenti ai comuni antibiotici, è importante ottenere presto gli antibiogrammi, e valutare attentamente la risposta terapeutica, per eventualmente cambiare regime di trattamento


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Grazie dell’attenzione

Domande?


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