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PLEUROPULMONARY TULAREMIA COMPLICATED BY PERIPHERAL NEURITIS

MORTIMER RAPHAEL, M.D.; AUGUSTUS E. ANDERSON, M.D.
AMA Arch Intern Med. 1953;91(2):278-280. doi:10.1001/archinte.1953.00240140138009.
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SINCE the discovery of Pasteurella tularensis by McCoy1 in 1910 and the demonstration that it produces disease in man, as reported by Francis2 in 1922, tularemia has been found masquerading in many forms. These have been classified as ulceroglandular, oculoglandular, glandular, and typhoidal; occasionally are added pleuropulmonary and oral-abdominal forms.

Initial pathologic changes occur at the site of inoculation of the organism, and a bacteremia soon follows. The organism then appears to have a predilection for lodging in the lungs, liver, spleen, and lymph nodes. Following the septicemia, neurological symptoms and signs may appear, the most frequent being nonspecific phenomena; i. e., delirium, stupor and restlessness. These have been attributed to the severe septic or toxic state induced by the organism. The next most frequent neurological complication is lymphocytic meningitis.3 Finally, there have been two reported cases of encephalitis.4 The case of tularemia reported here is unusual in that the

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