Tularemia pneumonia in Oklahoma, 1982-1987.

OBJECTIVE

We assessed the incidence, risk factors, and prognostic implications of tularemia pneumonia in Oklahoma from 1982 through 1987.

DESIGN

We retrospectively reviewed all reported case-patients over the six-year period 1982-1987.

SETTING

Department of Health in Oklahoma, where tularemia is known to be endemic.

PATIENTS

Of 128 patients with tularemia who entered the study, 32 had pulmonary involvement.

MAIN RESULTS

Compared to patients without pulmonary involvement, those with tularemia pneumonia were older (52 vs 32, p less than .0001), less likely to give a history of vector exposure (25% vs 7%, p less than .05), more likely to present with typhoidal illness (56% vs 15%, p less than .0001), hospitalized longer (11.6 vs 4.7 days, p less than .001), more likely to have a positive culture (9 vs 7, p less than .01), and more likely to die (4 vs 1, p less than .01).

CONCLUSIONS

Patients with tularemia pneumonia often present without historical or physical examination findings that suggest the diagnosis; thus, tularemia pneumonia often cannot be distinguished from other cases of community-acquired pneumonia. Therefore, especially in areas where the disease is endemic, tularemia must be considered in patients with pneumonia.