PLEUROPULMONARY TULAREMIA: OBSERVATIONS ON 12 CASES TREATED WITH STREPTOMYCIN

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Abstract
The effect of streptomycin in the treatment of 11 cases of tularemic pneumonia and 1 case of tularemic pleurisy is noted. These patients were seen in a period of a few mos. in Nashville, Tenn., and its vicinity, indicating that in this endemic area tularemic pneumonia is relatively common. 8 of the 12 patients had no primary ulcer of the skin and no significant enlargement of superficial lymph nodes; many of them presented marked difficulty in early diagnosis. There was a rapid and striking response to streptomycin treatment. Animal inoculation studies indicated that Pas-teurella tularensis was eliminated rapidly from the sputum and pleural fluid. In all patients, a rise in the serum agglutinin titer against P. tularensis occurred after treatment and, in certain instances, this rise was very marked. Because of the serious nature of tularemic pneumonia and the difficulties encountered in laboratory confirmation of the diagnosis, a therapeutic trial with streptomycin is suggested as a practical procedure in cases of severe atypical pneumonia occurring in regions where tularemia is endemic.

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