Tularaemia

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 12 Feb 2025

Last updated: 09 Jun 2023

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.

Definition

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.

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History and exam

Key diagnostic factors

presence of risk factors
fever
lymphadenopathy
painful skin ulcer
unilateral conjunctivitis

Full details

Other diagnostic factors

headache
malaise/fatigue
myalgia
anorexia
abdominal pain
vomiting
rales
non-productive cough/dyspnoea
sore throat
photophobia
vision impairment/loss
jaundice, hepatosplenomegaly, diarrhoea
positive Kernig's/Brudzinski's sign, stiff neck

Full details

Risk factors

tick exposure
biting fly exposure
contact with infected animals
outdoor work in areas where infected animals live
spring or summer season

Full details

Diagnostic investigations

1st investigations to order

FBC
serum electrolyte levels
LFTs
serum creatine kinase
urine dipstick for blood
erythrocyte sedimentation rate
serology
blood culture
specimen culture
polymerase chain reaction (PCR) of ulcer swab or lymph node aspirate

Full details

Investigations to consider

chest x-ray
lumbar puncture
histopathology

Full details

Emerging tests

antigen detection in urine

Treatment algorithm

ACUTE

tularaemia without meningitis

tularaemic meningitis

Contributors

Authors

William A. Petri, Jr., MD, PhD, FACP

Wade Hampton Frost Professor of Epidemiology

Professor of Medicine, Microbiology, and Pathology

Chief, Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

Disclosures

WAP declares that he has no competing interests.

Peer reviewers

Christopher Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

Disclosures

CH declares that he has no competing interests.

Beth Kirkpatrick, MD

Assistant Professor

Infectious Diseases

University of Vermont College of Medicine

Burlington

Disclosures

BK declares that she has no competing interests.

Differentials
- Tularaemic bacteraemia
- Cat scratch disease
- Toxoplasmosis
More Differentials
Guidelines
- Tickborne diseases of the United States: a reference manual for health care providers
- Tularaemia control guideline
More Guidelines
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Tularaemia

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

tularaemia without meningitis

tularaemic meningitis

Contributors

Authors

William A. Petri, Jr., MD, PhD, FACP

Disclosures

Peer reviewers

Christopher Huston, MD

Disclosures

Beth Kirkpatrick, MD

Disclosures

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice