Francisella tularensis Agent Specific Training

Francisella tularensis WARNING F. tularensis is highly pathogenic and has caused laboratory acquired infections. It should only be manipulated inside a Biological Safety Cabinet. How pathogenic? The infectious dose is as little as 5-10 ORGANISMS!!

Tularemia Humans become infected through several routes: Reported tularemia cases – – United States, 2004-2013 Humans become infected through several routes: Tick and deer fly bites Skin contact with infected animals Ingestion of contaminated water Laboratory exposure Inhalation of contaminated dusts or aerosols

Tularemia Clinical Presentation Ulceroglandular Most common Insect bite or handling infected materials Ulcer at site of infection with inflamed lymph nodes Glandular Similar to ulceroglandular without ulcer Oculoglandular Eye infection Irritation and inflammation of eye and swelling of lymph glands in front of the ear.

Tularemia Clinical Presentation Oropharyngeal Eating or drinking contaminated food or water Sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck. Typhoidal Unknown route of exposure Acute septicemia with no localizing signs Pneumonic Most serious Cough, chest pain, and difficulty breathing Breathing dusts or aerosols Bloodstream

Francisella tularensis Delete text and place photo here. F. tularensis may be found in the following: Blood Culture Direct smear from specimen Lymph node aspirate Biopsy (or swab) of lesion or wound Sputum or bronchial wash PHIL CDC/ Dr. Brachman

Francisella tularensis General Characteristics Minute Gram (-) Coccobacillus Faintly Staining Little to No Growth on SBA after 48 hrs. 1-2 mm Grey-White Colonies on CHOC after 48 hrs. Anne Hutchins, NCSLPH Brenda Mickens, NCSLPH

Francisella tularensis General Characteristics Grows very slow SBA supports growth initially CHOC, TM, BCYE or thioglycollate broth media that are Cysteine – enriched support better growth PHIL CDC Francisella tularensis on CHOC after 72 hrs.

Francisella tularensis CHOC 24 hrs. CHAB 24 hrs. Brenda Mickens, NCSLPH

Francisella tularensis CHOC 48 hrs. CHAB 48 hrs. Brenda Mickens, NCSLPH

All work done using BSL-3 practices Francisella Tularensis All work done using BSL-3 practices General Characteristics Tiny, Gram (-), coccobacilli from blood, lymph aspirate/biopsy, respiratory specimen or wound/ulcer/lesion Grows slow on CHOC, poorly or not at all on SBA at 72 hrs. Oxidase: (-) Catalase: (Weak +) Urease: (-) XV/satellite: (-) Beta-lactamase: (+) NOTE: Automated systems often key out as non- F. tularensis F. tularensis on CHAB at 72 hrs CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory

Francisella tularensis Assays Performed at the NCSLPH Typical Growth Characteristics DFA Slide Agglutination Real Time PCR Traditional Biochemicals Brenda Mickens, NCSLPH

LRN Algorithm