1. Francisella tularensis
Agent Specific Training

2. 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!!

3. Tularemia Humans become infected through several routes:
Reported tularemia cases – – United States,
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

4. 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.

5. 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

6. Francisella tularensis
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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

7. 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

8. 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.

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

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

11. 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

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

13. LRN Algorithm