CLINICAL ASPECTS OF TULAREMIA CASES COMPLICATED BY AFFLICTION OF THE NERVOUS SYSTEM

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• Collection: General CIA Records
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• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 3
• Document Creation Date: December 22, 2016
• Document Release Date: August 26, 2011
• Sequence Number: 860
• Publication Date: August 21, 1950
• Content Type: REPORT

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CLASSIFICATION SECRET )
CENTRAL INTELLIGENC
INFORMATION FROM
FOREIGN DOCUMENTS OR RADIO BROADCASTS
COUNTRY USSR
SUBJECT Scientific - Medicine
HOW
PUBLISHED Monthly periodical
WHERE
PUBLISHED Moscow
DATE
PUBLISHED Jan 1949
LANGUAGE Russian
op TOO UNITED STATED WITHIN Tn? .u.w.?- ~? --??-^^-- ?-- V. S. O.. SI AND Sl. AS ANIPDED. ITO TOASSS ISSIOM OD iNE EE'ItLAT1OS
I IS To An V
SI SITED NT TLA . 1 .NODUOTIOS OF THIS t0 N /SI SNON SIIflO. IS DAO?
DATE OF
INFORMATION 1949
DATE DIST. oy Aug 1950
NO. OF PAGES 3
SUPPLEMENT TO
REPORT NO.
THIS IS UNEVALUATED INFORMATION
SOURCE Klinicheskaya Meditsin, Vol XXVII, No 1, 1949
CLfNICAL ASPECTS OF TULAREMIA CASES
COMPLICATED BY AFFLICTION OF THE NERVOUS SYSTEM
N. Il'ina, Student,
Clinic of Nervous Diseases,
Voronezh Med Inst
Tularemia is a disease not only of the lymphatic system and skin, but
of the whole body, involving pathological processes of,ae nervous system.
Little attention was paid to the condition of the nerV6Vssystem in tulare-
mia cases until recently and the effect of the causative agent of tularemia
and its toxins on the nervous system remained unknown. At present, therein
are three papers published in Russian periodicals on worn done ~r -- --,
Finogenov, and Mirotvor$kiy which deal with the problem of neurotularemia.
This report is based on the observation of 21 cases of neurotularemia.
All of the patients had had one of the forms of tularemia in the past, which
was confirmed by their anamnesis, positive agglutination reaction, and re-
sults of intracutaneous allergy tests with tularin.
The clinical picture of neurotularemia can be divided into two periods:
the early and the late. The early period originates at the onset of the dis-
ease and is characterized by the inital reaction of the central nervous sys-
tem to intoxication. In this period, as Pervushin and Finogenov have pointed
out, headaches, disturbances of sleep (somnolence or more rarely, insomnia),
muscular pains, profuse perspiration of the legs, and sometimes"derangement
of consciousness to the point of hallucinations are observed at high tempera-
tures. When the temperature falls; general asthenia is sb4"ly 'expressed
and becomes the patient's main complaint. Asthenia and the oppressed psychic
condition are accompanied by pains, chills, and parethesia (numbness of the
arms and the sensation of ants crawling. -Tremor of the hands and eyelids,
quick tendinous reflexes, and increased muscular excitability were noted dur-
ing objective examinations.
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In the late period, sy111pto';a of the affection of the central nervous
system were found. In three cases a polyradicular syndrome was noted con-
sisting of the symptom of radicular pains, occasional peripheral paresis,
and reduction of radicle sensitivity.
We cite a case history as an illustration.
Patient Ch, 42 years old, reported on 5 June 1947 complaining of a
severe pain in the omall of the back which spread over the posterior sur-
face of the leg. In February 1947 he had been ill with the bubonic form
of tularemia. After 5 months, a minor constant pain appeared in the small
of the back, which was aggravated after chilling. The pain spread over the
posterior surface of the right thigh. Then the pain became very severe and
spread to the left thigh. The patient was unable to walk.
The patient was tearful and sensitive. There was fascicular twitching
in the muscles of the buttocks and in the posterior surface of the thighs.
Active movement of the legs was limited due to pain, and the muscular tonus
was diminished. The knee and achilles tendon reflexes were absent. There
was derangement of pain and tactile sensitivity, hypesthesia from the II
lumbar vertebra to the I sacral vertebra, and anesthesis from the I to the
V sacral vertebra. Complete sensitivity of the toes of the left foot was
absent. Lasegue's symptom and Neri's symptom were strongly positive.
There was atrophy in the muscles of the left thigh. No changes in the
spine were found by X-ray examination. The cerebrospinal fluid was normal.
The intracutaneous test with tularin and the agglutination reaction for
tularemia were positive.
Diffuse affections of the nervous system were observed in four patients.
In one case the affection of the medulla oblongata
was dominant, affection of the
that of the cerebrum. In a third case the symptoms medulla oblongata and the cerebrum with pseudobulbar and vegetative effects
predominated, and in the fourth case affections of the radicles and plexi
were observed. In all these patients the course of the disease was chronic
and progressive with periodic exacerbation.
We cite an example. Patient 5. 40 years old, reported on 17 April 1947
with a pain in the lower jaw joint and in the small of the back, general as-
thenia, a 4CtltiCiiC.y to and periodic increase in temperature to 37.5
'Cr:yi='e,
degrees. In December 1945 he had had the typhoid form of tularemia.
The right eye opened wider than the left. The mouth opend 3 centimeters,
and in showing the teeth, the right edge of the mouth droopel. The tongue
could be stuck out only as far as the front teeth. Hypesthesia on both
sides of the V to VIII cervical vertebra was found in determination of the
pain sensitivity. There was moderate atrophy of the muscles of the right
shoulder girdle, and slight hypotonia of the lower extremities. The knee
reflex was greatly reduced, more on the right side than the left. The mois-
ture of the skin was increased and there was a red outspread dermographism.
The hand and fingers tremored when the arm was extended. Romberg's sign
was positive. The paravertebral points were painful. Lasegue's symptom
was positive on the left side. The intracutaneous test and the agglutina-
tion reaction for tularemia were positive.
An encephalitis syndrome was observed in seven cases. Two cases with
the symptoms of Parlinsonism which had developed in direct connection with
tularemia were worthy of special interest. We found no similar cases in
medical literature.
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In the remaining seven cases, symptoms of the affection of the dien-
cephalon were found. Organic changes in the region then diencepinhalon ac-
count for emotional instability and symptoms of hysteria
patients.
It should be noted that in all urotulare is cases, found
instability expressed in varying llgre
subcortical and connective complications. In some patients we found, on the
basis of highly dilineated syndromes, unusual paraoxysms similar to those
described by Professors Itsenko and Penfield under the name "diencephalic
epilepsy."
Conclusions
1. The study of neurotularemia was started some time ago. Our data
is of a preliminary nature.
2. We studied 21 patients with neurotularemia. We confirmed
mathan re-
actions, patients have had tularemia by anamnestic data, positive aggul
actions, and intracutaneous allergy tests with tularin.
3. We observed polyradicular, encephalitic, and subcortical-diencephali-
tic symptoms, and the syndrome of diffuse affections of the nervous system in
cases of neurotularemia.
4. In all neurotularemia cases there were diencephalitic symptoms ex
pressed in varying degrees.
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