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.