Dear Evy:

Our little girl died from Francisella tularensis. 

Francisella tularensis is a pathogenic species of Gram-negative bacteria and the causative agent of tularemia.

The doctors just call it tularemia. In my research it is also known as ‘rabbit fever’. The exact cause of death is unclear, but it is thought to be a combination of multiple organ system failures.

Rabbits, hares, and rodents are most susceptible to the disease.The bacterium that causes tularemia is highly infectious and can enter the human body through the skin, eyes, mouth, throat, or lungs. Humans can become infected through several routes, including:

• Skin contact with infected animals
• Ingestion of contaminated water
• Laboratory exposure
• Inhalation of contaminated dusts or aerosols
• Tick and deer fly bites

So the conversation after the doctor told me the preliminary results went like this (summed up):

“Does Adam hunt rabbits?”  No.
“Has she been exposed to him processing or skinning animals?” No.
“Did she eat any wild game?”  No – she has never ate meat.
“Has she been in any lakes, ponds, creeks?” No only the bathtub.
“Did she have any marks from being bit from a tick or deer fly?” No.

Well it was assumed that even though she didn’t have any marks or rashes, that it had to be contracted from a tick or a deer fly that bit an infected rabbit or rodent and then bit her. There were no other options. Laboratory exposer was never discussed.

Tularemia has common symptoms so it is hard to diagnose. It usually takes 5 – 7 days to diagnose it properly. Evelyn didn’t have that much time. By the time they became concerned that she was really sick, more than just a viral stomach bug, she died. All of her organs already shut down. Her body was just too little. I knew she was more sick before that, but I guess doctors don’t go off of mother’s instinct.

Tularemia can also be transferred by domestic rabbits and cats. We have chickens and a dog. You wouldn’t believe how many times we told the doctors we had chickens just incase that would be the missing link. But tularemia is not found in chickens or transferred by dogs.

Tularemia can be common in landscapers or farmers. Most get confused and think that because we have a garden center, that we are also landscapers. We are not. Two separate items and not to mention Evy wouldn’t have gone with us on job sites. The reason landscapers and farmers are at risk is because they can mow large fields where a caracas of an infected animal could get ran over and the particles could be breathed in through the mouth or nose. Not much of a concern for Evy.

These are the main forms of tularemia off of the CDC website. Evy’s isn’t listed in the autoposy.

• Ulceroglandular This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
• Glandular Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.
• Oculoglandular This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of eye and swelling of lymph glands in front of the ear.
• Oropharyngeal This form results from eating or drinking contaminated food or water. Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.
• Pneumonic This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.

Her only options would be glandular or pneumonic. Indiana has only had 13 cases of tularemia from 2003 – 2012. I have searched on several websites trying to figure out a more in depth answer or how she contaminated the disease. Her case is just rare. Most get a rash. She didn’t. Most can be treated with antibiotics and live. She didn’t. They didn’t treat her with antibiotics until the last day because they thought it was viral and antibiotics could make it worse. There are specific antibiotics for tularemia so it might not have made a difference even if she would have gotten antibiotics sooner.

I know absolutely nothing about infectious diseases and most of my research is from Google. So I could be misinformed on some of my information. If anyone has more information or has heard of other cases, feel free to let me know. It’s just sometimes hard to wrap our head around the results. It doesn’t make sense how our 10 month old contracted the disease and why she didn’t show the more common signs. Did she really die just because of a deer fly or tick bite? Just crazy.