An Outbreak of Primary Pneumonic Tularemia on Martha's Vineyard

In the summer of 2000, there was an outbreak of tularemia on the island of Martha's Vineyard in Massachusetts. This case–control study identified 15 patients with Francisella tularensis infection, including 11 with primary pneumonic tularemia. One patient died. The patients were more likely than controls to have used a lawn mower or brush cutter in the two weeks before the illness. Tularemia is a bacterial zoonosis caused by the small, gram-negative coccobacillus Francisella tularensis . The organism may be found in contaminated water or soil, infected ticks, wild and domestic animals, and decaying animal carcasses. Mammals can acquire the infection through arthropod bites, direct contact with infected tissues, inhalation, or ingestion; person-to-person transmission has not been documented. After an incubation period of 3 to 5 days (range, 1 to 21), infection with F. tularensis can result in various clinical presentations, depending on the route of inoculation, the dose of the inoculum, and the virulence of the organism. Primary pneumonic tularemia results . . .