Francisella tularensis, the causative agent of tularemia, is another small Gramnegative coccobacillus that would likely cause a primary pneumonic presentation if delivered as an aerosol agent of bioterrorism. The agent is associated with a high attack rate due to its virulence: as few as 10 organisms can cause a pneumonic infection (Dennis et al., 2001). Inhalational tularemia presents with the abrupt onset of a febrile, systemic illness with prominent upper respiratory symptoms, pleuritic chest pain, and the variable development of pneumonia, hilar adenopathy, and progression to respiratory failure and death in excess of 30 percent of those who do not receive appropriate therapy (Dennis et al.,

2001). The diagnosis is generally based on clinical features after other infectious etiologies are ruled out. Laboratory personnel should be notified in advance if tularemia is suspected, because the organism can be very infectious under culture conditions.

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