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TULAREMIA, PNEUMONIC - USA (NEW YORK CITY) (04) International Society for Infectious Diseases http://www.isid.org Date: Mon 15 Nov 2004 From: Sally Slavinski sslavins@health.nyc.gov This is in response to the question regarding the route of exposure for the New York City (NYC) resident with tularemia. Interviews with the patient suggest mechanical transmission likely occurred through indirect contact with infected wild rabbits on Staten Island. The patient's 2 dogs visit a local park daily. One dog captured a wild rabbit and subsequently licked the patient on the face upon returning home. The events occurred approximately 7 to 10 days prior to the onset of illness, which is consistent with the incubation period for tularemia. The patient never visited the park or had direct contact with rabbits or rodents, and denied having any tick or insect bites. The patient suffered from severe acne and complained of having a swollen submandibular lymph node a few days prior to her onset of illness. The patient's 2 dogs had positive antibody titers for tularemia, and several rabbits collected from the park were positive by direct fluorescent antibody testing (DFA). All animal testing was graciously done by our colleagues at the Centers for Disease Control (CDC) in Ft. Collins, CO. -- Sally Slavinski, DVM, MPH, DACVPM New York City Department of Health and Mental Hygiene Zoonotic and Vectorborne Disease Unit