Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- spring or summer season
- fever
- localised unilateral lymphadenopathy
- painful skin ulcer
- unilateral conjunctivitis
Other diagnostic factors
- rales
- non-productive cough/dyspnoea
- systemic toxicity symptoms
- sore throat
- photophobia
- jaundice, hepatosplenomegaly, diarrhoea
- positive Kernig's/Brudzinski's sign, stiff neck
Risk factors
- tick exposure
- biting fly exposure
- contact with infected animals
- outdoor work in areas where infected animals live
Diagnostic investigations
1st investigations to order
- serology
- blood culture
- specimen culture
- polymerase chain reaction (PCR) of ulcer swab or lymph node aspirate
Investigations to consider
- chest x-ray
- lumbar puncture
- histopathology
Emerging tests
- antigen detection in urine
Treatment algorithm
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
VA
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
VT
Disclosures
CH declares that he has no competing interests.
Beth Kirkpatrick, MD
Assistant Professor
Infectious Diseases
University of Vermont College of Medicine
Burlington
VT
Disclosures
BK declares that she has no competing interests.
Differentials
- Tularaemic bacteraemia
- Cat scratch disease
- Toxoplasmosis
More DifferentialsGuidelines
- Tularaemia control guideline
- Tickborne diseases of the United States: a reference manual for health care providers
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