Active substances: Doxycycline
Treatment failure was associated with the ulceroglandular form of disease and the use of doxycycline as the initial treatment.
A second course of antibiotic treatment was given to 46 patients 32 because of therapeutic failure, 12 because of adverse drug reactions, and 2 because of incorrect completion of the treatment. The response was favorable for all patients except 6 4 who received ciprofloxacin, 1 who received streptomycin, and 1 who received gentamicin, who received a third course of macrolides.
The poor response in these patients was indicated by the persistence of the asthenia; all of them remained afebrile. Tularemia is a zoonosis caused by F. No previous outbreak had been reported in Spain.
The most notable epidemiologic finding was contact with hares. The microorganism was isolated from dead hares during the epidemic.Praesent lorem diam, congue et pharetra.
The illness was contracted through the handling and processing of the hares, but the infection mechanism of the hares is not known.
The most likely hypothesis is the importation of infected hares from countries where tularemia is endemic. Other possibilities, such as natural migration or transmission by birds, are unlikely because the epidemic remained localized in a specific geographical region.
The principal port of entry was the skin. The pathogen usually enters through small lesions in the skin, although it is possible that it can penetrate through grossly intact skin.
It seems impossible to rule out unnoticed small cuts or trivial skin lesions. Other possible routes of infection include the inhalation of aerosol droplets from the skin of dead animals, leading to the pneumonic or typhoidal forms of disease.
Additional routes of infection, such as tick bites, the eating of undercooked, contaminated meat, and the drinking of contaminated water, were not observed in the present study.
Also, the mechanism of infection of F. This pathogenetic mechanism explains the clear predominance of the ulceroglandular form of tularemia.
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