潛在的生物武器威脅:兔熱病

在911事件後，全球即壟罩在恐怖攻擊的陰影中。其中以大規模、毀滅性生物武器為手段的恐怖攻擊，更是世人心中揮之不去的夢魘。在眾多潛在的生物性威脅裡，土倫病（tularemia），又名兔熱病（rabbit fever），因其高傳染力和高致死率的特性，引起了政府和科學界的重視。兔熱病是一種由土倫病法蘭西斯氏菌（Francisella tularensis; 簡稱 F. tularensis）所引起的人畜共通感染疾病。臨床上已知兔熱病可以透過多種方式進行傳播，包括帶有病菌的節肢動物叮咬、接觸受感染動物的屍體、食用受污染的食物和水或攝入帶有病菌的懸浮微粒。F. tularensis可分為數個亞種，其中最致命的亞種為盛行於北美的A型土倫病法蘭西斯氏菌 （F. tularensis subp. tularensis）。肺炎型土倫病（pneumonic tularemia）為F. tularensis感染時最嚴重的病徵，其發生原因多為經由直接攝入方式感染土倫病法蘭西斯氏菌，或為經其它途徑感染所產生的潰瘍淋巴腺型土倫病（ulceroglandular tularemia）或傷寒型土倫病（typhoidal tularemia）的繼發疾病。鑒於土倫病法蘭西斯氏菌在公眾健康上的重要性，本文將就土倫病法蘭西斯氏菌感染時的臨床特徵、實驗室診斷和未來展望等方面，進行介紹與討論。

The world has been under the threat of terrorist attacks since the 911 attacks. Especially, those using massive and destructive biological weapons as a mean of attacks is an unforgettable nightmare to the people. Due to its high infectivity and high mortality rates, tularemia, also known as rabbit fever, has drawn much of the government's and the scientific communities' attention. Tularemia is a zoonotic disease caused by a pathogenic bacteria, Francisella tularensis (F. tularensis). In clinical, tularemia is able to spread through various vectors, including arthropod bites, direct contact with infected animal carcasses, eating contaminated food and water or inhaling bacteria on suspended particles. Of the four subspecies of F. tularensis, subspecies tularensis (type A) is the most virulent and mainly found in North America. Infection of F. tularensis can lead to different forms of diseases. In which, the pneumonic tularemia is the most severe and caused most frequently by direct inhalation or as a secondary disease after ulceroglandular tularemia or typhoidal tularemia. In light of its importance in public health, this paper briefly introduced and discussed the clinical features, laboratory diagnosis and future prospects of tularemia.