THE PROBLEM OF TULAREMIA RELAPSES

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• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-00809A000600330978-0
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 4
• Document Creation Date: December 22, 2016
• Document Release Date: August 30, 2011
• Sequence Number: 978
• Publication Date: August 25, 1950
• Content Type: REPORT

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CENTRAL INTELLIGENCE AGENCY
INFORMATION FROM
FOREIGN DOCUMENTS OR RADIO BROADCASTS
~- COUNT Y
USSR DATE OF
INFORMATION 1949
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WHERE
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Moscow
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SOURCE Klinicheskaya Meditsina, Vol 7GtVI2, No 1, 1949,
THE PROBLEM OF TULARENIIA RELAPSES
V. S. Sil'chenko
Voronezh
The problem of the development of relapses in people who previously have
had tularemia has not received wide coverage in medical literature. G. P.
Rudnev writes that, "Besides the early relapses (after 3-4 years) there is
denoted in the literature the possibility of relapses later (after several
months and even periods exceeding a year)." Fouche noted the appearance of.
relapses for a period of 8 months to 2 years after the onset of the disease.
Berfidskaya observed re~.apses after 1-2 yeei~. In our opinion, the inadequacy
of data on relapses of tularemia is due largely to the lack of longer follow-
up checking of those who have had the disease.
In this article we are citing the results of our investigations on patients
who had tularemia from late 1945 through early 1946 and, then had relapses during
1946. We are reporting only those cases in which there are sufficient data
to support the diagnosis of the initial attack of tularemia (in-patient exami-
nation, laboratory analysis, and data of epidemiological inspections). In
sll we observed ten patients who had tularemia. All these cases were the
bubonic or anginous-bubonic form of tularemia.
We cite a Pew short case histories:
1. Patient K, 45 years old, became ill on 15 December 1945. The onset
of the disease was rapid, with a sudden rise of the temperature to 40 degrees.
On 19 December, small bilateral cervicel buboes were observed. Intracutaneous
test with tularin was 0.5 x 0.5 centimeters. The agglutination reaction for
the first week of the illness. was negative. During nearly 2 months of hospitali-
zation the buboes enlarged to the size of a tangerine and abscessed; they
were then lanced. Three weeks after the lancing the secretion of pus stopped.
^.'he pa!~ient *~as discharged for work at the end of February 191?6, bud continued
to feel weak for 2 months.
B
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On 2;i October, after 8_mogths, he, complained. of pains in the. throat and
in the muscles: of the arms and legs, and general asthenia. Temperature was
37 degrees. Diagnosis: angina catari~halis. Cn 27 October his temperature
was 38 degrees. Bilateral submaxillary buboes appeared. Diagnosis: tularemia
(relapse). On 29 October the intracutaneous test was 2 x 2 centimeters. The
.agglutination reaction was strongly positive in a dilution of 1:100. On,
31 October temperature was normal. The buboes had enlarged: the right side
to the size of a hen's egg, the left to that of a walnut. The buboes were
hard without soft points and were painful only when strongly squeezed. On
5 November the buboes were unchanged. The agglutination reaction was strongly
positive in a dilution of 1:100.
Treatment: bandage with ichthyol ointment, and red prontosil intern-
ally. During November the patient felt very weak, but his temperature was
normal. The buboes started to decrease in size and by mid-December were com-
pletely resolved.
2. Patient S, 21 years old, became i.~'_ 18 January 1946. In his home
there were many mice, among which carriers were found: He reported to the
polyclinic on the fifth day of the disease complaining of a high temperature,
pain in the throat, and an enlargement of the submaxillary lymph nodes on the
right side.
Temperature was 37 degrees and the throat was hyperemic. There was
a bubo the size of a walnut under the right side of the jaw. Diagnosis:
lymphadenitis. On 31 January an incision of the bubo was made. During
February the patient's temperature was normal in the morning but rose to 38
degrees by evening. On the right cheek near the cochlea a bubo appeared the
size of.s woodnut with subsequent softening and spontaneous opening. The
intracutaneous test was 3 x 4 centimeters. Diagnosis: tularemia. By May
the fistula healed three times and reopened and then the emission of pus stop-
ped. The bubo disappeared. Asthenia of the patient was noted until July.
On 23 November (after 6 months) the temperature suddenly rose to
38 degrees. There was pain on the right side of the neck, and a ringing in
the right ear. Thereafter, the temperature in the morning was normal, but by
evening rose to 37.8 to 38 degrees. On 2y November a small bubo appeared on
the right cheek. The patient was sent to the tularemia station by t'he poly-
clinic.
On 3 December his throat was normal. Astar-shaped scar had healed
on the skin under the right side of the lower ,jaw. There was also s scar on
the right cheek. In addition,, there was a hard painful bubo, the size of a
bean, on the cheek at the level of the external auditory canal. Intracutaneous
test was 2.5 x 2.5 centimeters. Agglutination reaction was positive in a dilu-
tion of 1:200. Diagnosis: tularemia (relapse).
Treatment: ichtyyol in the region of the bubo; internally, red proa-
tosil. Complete resolution of the bubo without abscessing by the end of
December 1946. '
3. Patient P, 23 years old, an inhabitant of village?P, became sick
in March 1946. At that time is the village there were patients with buboes,
two of them in the patient's family. The disease struck suddenly, the tempera-
ture rose to 38.5 degrees, and swallowing was .painful....On_.the third day buboes
were found on the neck under the lower ,jaw on both sides. A bubo also appeared
on the internal angle of the right eye socket. An intracutaneous test with
tularin was positive. Diagnosis: tularemia. The temperature after 2 weeks
returned to normal, and the bubo started to decrease in size and completely
disappeared in May 1946.
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On 28 August, after 3z months, the temperature suddenly rose to 39
degrees. After a time the temperature was normal in the morning but rose by
evening. There were severe headaches all the time. After 10 days the tempera-
ture stayed normal, but buboes appeared and started to grew in the same places
as in :.arch, but thin time they were le*-'ger. The par.ient was treated in the
polyclinic for more than a month. On 5 October symmetrically placed bilaterial
submaxillary buboes the size of a hen's egg were observed. In the region of
the bridge of the nose and the interior angle of the right eye socket, there
was a bubo the size of a plum and there was hyperemia of the skin in this
section. The intracutaneous test was 0.5 x 0.5 centimeters. The agglutination
reaction was positive in a dilution of 1:100.
4. Patient Sh, 38 years old, became sick at the end of December 1945?
At that time in his village mortality of mice and cats was detected, and among
the villagers there were tularemia patients. Onset of the illness was rapid.
The temperature rose suddenly, and he began to notice a pain in the throat.
After 5 days a bubo appeared on the right side under the lower ,jaw. Diagnosis:
tularemia (anginous-bubonic form). Hospitalized for a month. The bubo was
resolved.
At the end of October 1946, after 9 months, a small hard spot appeared
under the lower right ,jaw in the same place as in December 1945, and after that
a bubo appeared which started to grow rapidly. Temperature was normal.
On 10 October there was no change in the throat. There was a dense
and insensitive bubo on the right side under the lower ,jaw the size of a walnut.
The intracutaneous test was 1 x 1 centimeters. The agglutination reaction
was positive in a dilution of 1:400. '
In October the bubo continued to grow; it reached the size of a hen's
egg, and developed a softened zone. In November the temperature rose in the
evening to 38 degrees. In mid-November spontaneous opening of the bubo occurred.
In December the fistula closed again after a month. The patient was unable to
work. Severe asthenia, headaches, and perspiration of the legs were noted.
5. Patient K, 53 years old, became sick in February 1946. In the sovkhoz
where he worked there were cases of tularemia. The temperature rose rapidly
to 40 degrees, and he began to have headaches and pains in the throat and
muscles. After 1~ weeks a submaxill.ary bubo appeared on the right aide.
Diagnosis: tularemia (anginous-bubonic form). After l~ months the bubo was
resolved.
On 10 October, after 6 months, his throat became sore and his tempera-
ture rose to 39 degrees. He suffered headaches and loss of appetite. After
2 days he began to feel pain at the point where the, bubo had been and then
the bubo formed again and began to grow. The increase in temperature lasted
for only 2 weeks. He continued to feel very weak.
On 2 November there was some hyperemia of the throat. The bubo was
hard, the size of a walnut and somewhat painful. The intracutaneous test was
3 x 4 centimeters. The agglutination reaction was strongly positive in dilu-
tions of 1:100. Diagnosis: tularemia (relapse). On 13 November there was
severe asthenia and the legs perspired. The bubo was reduced. The repeated
agglutination reaction was strongly positive in dilutions of 1:100. Treatment:
ichthyol bandage; internally, red prontosil. In December the bubo was reduced
to the size of a woodnut;. Early is February pain occurred in the throat
again and the temperature rose to 38 degrees. The bubo grew to the size of
a hen's egg. Symmetrical to ii on the left side under the lower ,jaw, there was
a new bubo the size of a plum. Diagnosis: relapse of tularemia. The bubo on
i.iie left resolved and the one on the right began to grow s:..aller. For several
months the patient lcst considerable weight, and noticed progressive asthenia,
periodic shooting pain in the region of the heart, and an appreciable reduction
or working ability. On 30 March the bubo on the right side was indolent and
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The relapses of tularemia usually appeared 6-7 months after (recovery
of the buboes) but in some cases we noted them earlier, after 3~ months, and
later, after 11 months. In one patient we observed two relapses during a year.
All relapses were either bubonic orb more often, anginous-bubonic forms of
tularemia.
As a rule, the buboes reappeared in the same places as in the initial
illnesses, but also occurred in new sections.
In some cases the diagnosis was for catarrhal disease. The possibility
of reinfection was nullified by epidemiological data. The majority of the
cases of relapse investigated by us involved patients from one population
center and i.ts surrounding villages.
In the majority of cases the relapses started quickly without preliminary
symptoms. Sudden rise in temperature and symptoms of angina were observed.
The period of fever lasted 5-14 days. The buboes appeared on the third to
the tenth day. We did not notice any special features in the development of
the buboes in contrast to the original process. It should be noted that in
the investigated grouF~ the buboes in the relapses were larger than those
in the original illnesses. In all cases, development of the tuboes was com-
pletely reversed and in only one case was there suppuration of the bubo.
The above data enable us to assume the possibility of a greater number
of tularemia relapses than had been throught~o occur, and demons?rate the
necessity of more extensive treatment of this problem in the future.
A case of relapse which we are investigating at the present is also very
itti:ci'esting.
Patient L, 43 years old. In the latter part of March 1942, his tempera-
ture rose suddenly to 40 degrees. There were pains in his throat and muscles,
and he had a severe headache. A diagnosis of angina was made. After 4 days
his temperature dropped to 38 degrees, and later to 37.8 to 38 degrees. At
the end of the third week he began to have difficulty in breathing. Our
diagnosis of tularemia was supported by serological tests. He was hospitalized
for nearly a month. Temperature during this time stayed normal, and the pain
in the throat disappeared. There were no buboes.
In the first part of April 1947, without any general symptoms (temperature
was normal) a bubo appeared on the left side of the neck, and began to grow
until it peached the size of~an apple. Treatment with quartz showed no results.
On 29 May an indolent bubo the size of a tangerine appeared on the left
side behind and below the ear in the region of the sternocleidomastoid muscle.
The skin in this region was pigmented and slightly exfoliated. On 30 May
an intracutaneous test was 2 x 2 centimeters after 24 hours. After 48 hours
the zone of the infiltrate had extended to 4 x 5 centimeters. On 31 May the
agglutination reaction was positive in a dilution of 1:b00.
In this case the patient was afflicted with the generalized form of tula-
remia for 5 years before the appearance of the bubo. The possibility of rein-
fectio^. was not supported by epidemiological data and the clinical picture of
the d3Fease. Apparently in this case it was retarded relapse of tularemia,
which is very rarely found.
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