Appendix B: Provincial Case Definitions for Reportable Diseases
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1 Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Reportable Diseases Disease: Tularemia Revised
2 Tularemia 1.0 Provincial Reporting Confirmed and probable cases of disease 2.0 Type of Surveillance Case-by-case 3.0 Case Classification 3.1 Confirmed Case Laboratory confirmation of infection with clinically compatible signs and symptoms: Isolation of Francisella tularensis from an appropriate clinical specimen (e.g., blood, sputum) A significant (i.e., fourfold or greater) rise in serum antibody titre to F. tularensis antigen 3.2 Probable Case Laboratory support of infection with clinically compatible signs and symptoms, and Detection of F. tularensis by nucleic acid amplification testing (NAAT) Detection of F. tularensis in a clinical specimen (e.g., lymph node aspirates, ulcer exudate) by fluorescent assay 1:128 microagglutination titre or 1:160 tube agglutination in a single serum specimen 4.0 Laboratory Evidence 4.1 Laboratory Confirmation Any of the following will constitute a confirmed case of tularemia: A significant (i.e., fourfold or greater) rise in F. tularensis antibody titre Positive F. tularensis culture (See Section 4.2) 4.2 Approved/Validated Tests F. tularensis serology Standard culture for F. tularensis Direct fluorescent antibody (DFA) for F. tularensis cellular antigens 2
3 F. tularensis NAAT Slide agglutination for F. tularensis 4.3 Indications and Limitations N/A 5.0 Clinical Evidence Clinically compatible signs and symptoms are characterized by several distinct forms, including the following: o ulceroglandular cutaneous ulcer with regional lymphadenopathy; o glandular regional lymphadenopathy with no ulcer; o oculoglandular conjunctivitis with preauricular lymphadenopathy; o oropharyngeal stomatitis or pharyngitis, or tonsillitis and cervical lymphadenopathy; o intestinal intestinal pain, vomiting, and diarrhea; o pneumonic primary pleuropulmonary disease; and o typhoidal febrile illness without early localizing signs and symptoms. Clinical diagnosis is supported by evidence or history of a tick or deerfly bite, exposure to the tissues of a mammalian host of F. tularensis, or exposure to potentially contaminated water. 6.0 ICD Code(s) ICD 10 Code A Comments N/A 8.0 Sources Acha PN, Szyfres B. Zoonoses and communicable diseases common to man and animals. 3 rd ed. Vol I, Bacterioses and mycoses. Washington DC: Pan American Health Organization; Advisory Committee on Epidemiology; Health Canada. Case definitions for diseases under national surveillance. Can Commun Dis Rep. 2000;26 Suppl 3:i-iv, Available from: Heymann DL, editor. Control of communicable diseases manual. 19 th ed. Washington, DC: American Public Health Association; National Notifiable Diseases Surveillance System [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; case definition: Tularemia; [updated 2014 May 3
4 8; cited 2014 Jun 26]. Available from: 12:00:00 AM 9.0 Document History Table 1: History of Revisions Revision Date Document Section Description of Revisions General New template. Title of Section 8.0 changed from References to Sources. Section 9.0 Document History added. 3.2 Probable Case Entire section revised. 4.1 Laboratory confirmation 4.2 Approved/Validated Tests 4.3 Indications and Limitations Tularemia changed to lower case tularemia. Removal of with confirmation from second bullet. NAT changed to NAAT. Removal of last bullet Confirmatory methods include DFA Removal of Additional tests may include 5.0 Clinical Evidence Format changed into bulleted form. 8.0 Sources Updated. Francisella tularensis changed to F.tularensis. 4
5 2014 Queen s Printer for Ontario
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