Pneumonic tularemia on Martha's Vineyard - Clinical, epidemiologic, and ecological characteristics
Pneumonic tularemia on Martha's Vineyard - Clinical, epidemiologic, and ecological characteristics
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DOI：
10.1196/annals.1409.013
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发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Telford, Sam R., III
中科院分区：
文献类型：
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作者：
Matyas, Bela I.;Nieder, Henry S.;Telford, Sam R., III
马萨诸塞州的玛莎葡萄园岛是美国仅有的两次原发性肺炎土拉菌病暴发的地点。从2000年开始，一直持续到2006年，玛莎葡萄园岛报告了59例推定或确诊的兔热病病例，其中60%以上推定是由于吸入了该制剂。CDC/马萨诸塞州公共卫生部的一项联合病例对照研究发现，修剪草坪或修剪灌木等景观活动是重要的风险因素。然而，作为园艺师风险基础的污染物仍然没有确定。临床上，病例通常有肺炎成分，但肺部体征的发展可能会大大延迟。疾病的范围从相对较轻的疾病（可在门诊治疗）到需要住院治疗的严重疾病不等。在每种情况下，庆大霉素治疗往往会迅速诱导退热，尽管也有例外。即使在当前疫情期间提高了认识，医生也很容易错过土拉菌病的诊断，通常将疾病归因于更常见的发热性疾病。狗蜱似乎在这个岛上维持了病原体，多达5%的人感染了兔热病。狗蜱、臭鼬和浣熊的主要宿主经常具有血清反应性，这表明由于它们的生活习性，它们可能参与环境污染。为什么兔热病在玛莎葡萄园岛流行，为什么它通常表现为肺炎，仍然没有描述。
Martha's Vineyard, Massachusetts, is the site of the only two recognized outbreaks of primary pneumonic tularemia in the United States. Beginning in 2000 and continuing through 2006, 59 presumed or confirmed tularemia cases have been reported from Martha's Vineyard, with more than 60% of these presumed to be due to inhalation of the agent. A joint CDC/Massachusetts Department of Public Health case-control study identified landscaping activities such as lawnmowing or brush cutting to be important risk factors. The fomites that serve as the basis for risk for landscapers, however, remain unidentified. Clinically, cases generally have a pneumonic component, but the development of pulmonary signs can be greatly delayed. The spectrum of illness ranges from relatively mild disease, in which cases may be treated on an outpatient basis, to severe illness requiring hospitalization. In each scenario, gentamicin therapy tends to rapidly induce defervescence, although exceptions have been noted. Even with heightened awareness during the current outbreak, physicians may easily miss a diagnosis of tularemia, usually by attributing illness to the more common Febrile illnesses. Dog ticks appear to maintain the agent on this island, with as many as 5% infected by the agent of tularemia. The main hosts for dog ticks, skunks and raccoons, are very frequently seroreactive, suggesting the possibility for their involvement in environmental contamination due to their peridomestic habits. Why tularemia is prevalent on Martha's Vineyard and why it commonly presents as a pneumonic disease there remain undescribed.