The Hazards of Lawn Care

It's a hot summer day and you need an excuse not to go outside to mow the lawn.

How about this one: "But honey, it could start an epidemic." Or maybe, "But Dad, we

could be arrested as bioterrorists under the Patriot Act." Now those are really novel

excuses. Here's why they might work.

There's an unusual infectious disease that is sometimes referred to as "lawnmower

tularemia." It is caused by a bacterium called Francisella tularensis, and one of the risk

factors for catching it is mowing the grass. At least that's true in certain places.

Martha's Vineyard, for example, has had recurring outbreaks in recent years. In

2000, fifteen people on that celebrity-filled island came down with tularemia and one

man died. The Centers for Disease Control investigated the outbreak by having some of

their scientists collect air samples while mowing lawns. They wore white isolation suits

and battery-powered respirators because the bacteria are tough. They can persist in

water, mud and grasses for weeks or months. Perhaps it is no surprise then that the

spinning blades of a mower can stir them into the air, and into someone's lungs.

As few as 10 tularemia cells can cause severe illness and death, thus making this

bug one of the most infectious bacterial pathogens in the world. That's why it's also on

the federal ‘bad bug’ list along with plague, smallpox, Ebola and anthrax. Tularemia is

considered to be a potential agent of bioterrorism and a few nations—us included—have

tried to weaponize it.

Fortunately, it is not contagious, which means there is no person-to-person

transmission so you can't catch it from your neighbor. That makes tularemia less likely

1
to be a weapon of mass destruction and more like a weapon of mass disruption. (Imagine

hundreds of people with pneumonia showing up at the local emergency room.)

During 1990-2000, the CDC recorded 1,368 cases of tularemia in 44 states. The

disease is often described as a sudden febrile illness. Depending on the route of

infection, there may be an ulcer on the skin, ocular lesions, pharyngitis from eating or

drinking contaminated foods, or pneumonia. Pneumonia has the highest fatality rate.

Tularemia is treated with antibiotics, but there is no vaccine licensed in the U.S.

Cases have been associated with lawn mowing and clearing brush, tick and

deerfly bites, and handling rodents and rabbits. The disease has often been called “rabbit

fever” because hunters sometimes contracted pneumonias and skin infections from

handling dead rabbits.

Rabbits may also be the source of some cases of lawnmower tularemia. The first

two documented cases of lawnmower infection in the U.S. occurred when two boys ran

over a dead rabbit while cutting the grass. The resulting “aerosol” was probably laced

with tularemia bacteria and the boys breathed in some of the bacterial cells. (Knowing

this, I decided last month not to run over the rabbit remains left on the front lawn by our

cat. Better to stop the mower, move the body, and wash my hands than to become a case

report in someone else's column.)

Of course, people have been contracting tularemia since before the invention of

the gas-powered lawnmower. Hunters and farmers who came in contact with infected

animals, brush, and hay were common victims.

2
 Ticks are also a major source of F. tularensis. The common dog tick is a

recognized source and transmitter of tularemia. So there's another reason to do a 'tick

check' of pets and kids during the summer.

Then there is the black-tailed prairie dog. They are not native to Maryland, but

they have a habit of getting around via the exotic pet trade, and then giving people

tularemia. Frequently a source of bubonic plague out West, the cute prairie dog landed

on the front pages of newspapers in 2003 when they were discovered to be carrying the

rare African monkeypox virus. Now a 2004 report in the journal, Emerging Infectious

Diseases, confirms that the little critters also can transmit tularemia to people.

Not many people own prairie dogs or live near their colonies, but all of us

encountered mosquitoes during some part of the year. They may be yet another source of

tularemia. In 2000, Swedish authorities investigated an outbreak of some 270 cases of

tularemia in areas not previously known to be endemic for tularemia. Swollen lymph

nodes and skin infections were common symptoms—as opposed to pneumonia—and

mosquitoes seemed to be the source of the tularemia cases.

So next time you have to mow the lawn put on some DEET insect repellent, slip

on a mask, and check the yard for rabbits. Or just hire that kid down the street to cut the

lawn.