Two cases of tularemia in hunters from rural Newfoundland

• Published in: Official Journal of the Association of Medical Microbiology and Infectious Disease Canada
• Main Authors: Sullivan, Andrew P, Nicholson, Catherine, Bradbury-Squires, David J, King, Amy, Daley, Peter
• Format: Article in Journal/Newspaper
• Language: English
• Published: University of Toronto Press Inc. (UTPress) 2022
• Subjects: Infectious Diseases; Microbiology (medical); Canada; Newfoundland
• Online Access: http://dx.doi.org/10.3138/jammi-2020-0015; https://jammi.utpjournals.press/doi/pdf/10.3138/jammi-2020-0015

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.