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The behavior of leukocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in tularemia caused by Type B of Francisella tularensis was analyzed in different clinical forms and severities of disease in 101 adult tularemia patients. The mean leukocyte count was 8.3 X 10(9)/l and the leukocyte differential count was also usually normal. The behavior of leukocytes was similar in different clinical forms and severities of tularemia. The changes in differential counts were milder than reported earlier. Both CRP and ESR were higher in severe than in milder forms of tularemia (p less than 0.05 and p less than 0.01, respectively), and CRP was higher in pulmonary than in ulceroglandular tularemia during the second week (p less than 0.05). There were high individual CRP concentrations of up to 225 mg/l in acute tularemia but there were also low CRP values (10-40 mg/l). Thus the behavior of CRP in tularemia resembled that seen in tuberculosis, and CRP did not always allow differentiation of tularemia from viral diseases.

Grivet monkeys infected with virulent Francisella tularensis Strain Schu S4 showed significant early changes in serum levels of trace metals, triglycerides and activities of alkaline phosphatase, lactate dehydrogenase and alpha-hydroxybutyrate dehydrogenase. Free amino acid levels decreased slightly and there was a marked increase in the phenylalanine: tyrosine ratio. Serum lysozyme activity and seromucoid levels also increased. Kanamycin therapy produced remission of overt signs but the changes in blood constituents were less readily affected. Immunization with the live vaccine strain of F. tularensis induced transient responses similar to those resulting from Schut S4 infection. Immunized monkeys subsequently challenged with the virulent Schu S4 strain showed no clinical signs or marked changes in blood constituents.

Alteration of the rabbit serum lipids as a result of three bacterial infections was studied by quantitative thin-layer and gas-liquid chromatography. Anthrax infection slightly changed the serum lipid. Cholesterol did not change, though free fatty acids, triglycerides, and cholesteryl esters doubled, and lecithin increased threefold. Tularemia infection produced drastic changes in the serum lipid content of rabbits, increasing levels of cholesterol over 4-fold, free fatty acids 17-fold, triglycerides 11-fold, cholesteryl esters 2.5-fold, and lecithin almost 3-fold. Pneumococcus infection increased cholesterol 2.5 times, free fatty acids were more than doubled, triglycerides were increased 9.5 times, and lecithin was increased almost 4 times. Gas-liquid chromatographic analysis of the methyl esters of free fatty acids showed only quantitative changes in these acids due to infection. Some possible mechanisms of alteration of serum lipid content are discussed.

The pathogenesis of tularemia was studied in groups of rhesus monkeys (Macaca mulatta) that inhaled graded 10-fold doses ranging from 10 through 10(6) organisms of Francisella tularensis 425, a strain highly virulent for the white mouse but of reduced virulence for the domestic rabbit. Mean incubation periods ranged from 3 to 6 days followed by acute illness lasting 5 to 11 days with subsequent recovery of most animals. The higher inhaled doses resulted in shorter incubation periods, longer and more severe acute illnesses, and 18% mortality at the highest dose. Strain 425 multiplied in the lungs, disseminated to the regional lymph nodes, and became systemic. Maximal bacterial populations in tissues were reached by the 7th day after exposure of the animals regardless of the number of organisms inhaled. F. tularensis was no longer recoverable from any of six tissues examined 2 months after exposure. The most significant tissue changes occurred in the lungs; these consisted of foci of liquefaction necrosis, lobular consolidation, and pleural effusion and adhesions. The data indicate that the inhaled dose of strain 425 determined the maximal growth of the organism in the lungs which in turn influenced the severity of the usually self-limiting pneumonia and systemic infection. Although the monkey is less resistant to tularemia than is man, this laboratory animal when infected with F. tularensis 425 provides a useful model for the self-limiting type of human pulmonary tularemia usually observed in Europe and Asia but to a lesser extent in North America.