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Fransicella tularensis , a facultative intracellular pathogen, causes tularemia by mainly infecting phagocytic macrophages (Clemens et al., 2004)

[1] [4] Healthcare providers should consider alternative therapies with established safety profiles in pregnant or lactating patients whenever possible, and if glutathione injection is deemed necessary, close monitoring of both mother and child is recommended throughout treatment

Confirmatory diagnostic studies should be performed prior to initiating therapy, if possible, and the patient should be followed with appropriate studies to demonstrate hematologic improvement (Hgb, hematocrit, RBC, reticulocyte count)

The cardinal symptoms are usually a more or less pronounced hoarseness, limitations in voice projection accompanied by fast vocal fatigue