Tularemia Pneumonia in Urban Children

Tularemia pneumonia occurred simultaneously in five children in urban Baltimore. The features of this outbreak are reported to document the mild nature of the pneumonic illness and thus to emphasize the variability of the pulmonary manifestations of Francisella tulareusis infection. These cases also serve as a reminder to physicians that tulareniia, an infrequently encountered illness, is endemic in the United States. CASE REPORT Three previously healthy brothers, T.W., J.W., and R.W., 8, 10, and 14 years of age, were seen at the Baltimore City Hospital Outpatient Clinic with a history of fever of ten days' duration. The temperatures, compulsively documented by their mother, ranged from 37.8 to 40.0 C (100 to 104 F) daily and did not abate with antipyretics or the oral administration of penicillin prescribed by the family physician at the onset of fever.