During an outbreak scenario, IP should take what action when new patients present with skin ulcers and gram-negative coccobacilli in blood cultures and all are local farmers?

• A. Quarantine the patients
• B. Notify public health of a possible category A bioterrorism agent (Francisella tularensis)
• C. Start empiric antibiotic therapy
• D. Isolate each patient with contact precautions

Answer: (B)

Think about a cluster of patients with skin ulcers and gram-negative coccobacilli in blood cultures among local farmers—this pattern strongly suggests tularemia caused by Francisella tularensis. That organism is a Category A bioterrorism agent because it can cause severe disease and has properties that could be exploited for harm, including potential airborne spread and rapid dissemination. The most important first step for infection prevention and control is to notify public health authorities so they can coordinate an investigation, confirm the diagnosis, ensure laboratory safety measures, and guide the overall response for patients and staff. Quarantine is not typically required since person-to-person transmission is rare, and isolation with contact precautions is not the primary action in this scenario. While treating the patients promptly with appropriate antibiotics is essential, the urgent action in this outbreak context is to alert public health to trigger a proper public health response.