Tularaemia is spread by ticks, biting flies, direct contact with infected animals or animal skin, or inhalation of aerosols when doing outdoor work where infected animals live.
Classified as 7 distinct forms, each of which presents as a different clinical syndrome.
Diagnosis requires a high index of suspicion from the clinical presentation, although it can be confirmed only by serological testing.
Antibiotic treatment with an aminoglycoside or ciprofloxacin is the mainstay of therapy in all patients, regardless of the clinical syndrome. Doxycycline may also be used.
Prognosis following treatment is excellent.
Tularaemia is an infectious disease caused by the gram-negative bacteria Francisella tularensis. It is spread by ticks, biting flies, or direct contact with infected animals or animal skin. It may also be spread by inhalation of aerosols when doing outdoor work (e.g., mowing the lawn) where infected animals live.
History and exam
Key diagnostic factors
- presence of risk factors
- spring or summer season
- localised unilateral lymphadenopathy
- painful skin ulcer
- unilateral conjunctivitis
Other diagnostic factors
- non-productive cough/dyspnoea
- systemic toxicity symptoms
- sore throat
- jaundice, hepatosplenomegaly, diarrhoea
- positive Kernig's/Brudzinski's sign, stiff neck
- tick exposure
- biting fly exposure
- contact with infected animals
- outdoor work in areas where infected animals live
1st investigations to order
- blood culture
- specimen culture
- polymerase chain reaction (PCR) of ulcer swab or lymph node aspirate
Investigations to consider
- chest x-ray
- lumbar puncture
- antigen detection in urine
tularaemia without meningitis
- Tularaemic bacteraemia
- Cat scratch disease
- Tularaemia control guideline
- Tickborne diseases of the United States: a reference manual for health care providers
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer