Tularemia in Man from a Domestic Rural Water Supply

Abstract

An explosive water-borne epidemic of tularemia in the Union of Soviet Socialist Republics in 1935 was reported by Karpoff and Antonoff (1). Over 43 cases were observed in a group of farm laborers who used water from one stream which was found to be contaminated with Pasteurella tularensis. The portal of entry of infection appeared to be the tonsils and buccal mucosa and in some cases the conjunctiva. The anginal form of the infection predominated, but typhoidal and oculoglandular forms were present. Cultures were isolated from some experimental animals injected with tissues from a patient and from others injected with water from the suspected stream. Twenty-one patients were tested after the thirty-fifth day of illness for agglutinins against P. tularensis, and all were positive. Contamination of natural waters in Montana with P. tularensis was reported by Parker, Jellison, Kohls, and Davis (2); Jellison, Kohls, Butler, and Weaver (3); and by Parker, Steinhaus, and Kohls (4). Since 1942 contamination of numerous streams at one time or another, often persisting for months, has been repeatedly demonstrated at the Rocky Mountain Laboratory. In most instances, the presence of the organism in water has been associated with the occurrence of tularemia in beavers and muskrats inhabiting the streams or ponds concerned. Many cases of tularemia have been contracted by persons who skinned or handled such diseased animals, but to the present there has been little evidence of human infection resulting from direct contact with contaminated water. The occurrence in Gallatin County, Mont., of four cases of tularemia associated with one domestic water supply under circumstances which appear to preclude other likely sources of infection is the subject of the present report. In the summer of 1949, two cases of tularemia, in which the portal of entry appeared to be the throat, were treated by one of the authors (Epler). Neither patient exhibited an external initial lesion of any kind, and neither gave a history of close contact with wild rodents,