Tularemia

Last reviewed: 28 Apr 2022
Last updated: 16 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • spring or summer season
  • fever
  • localized unilateral lymphadenopathy
  • painful skin ulcer
  • unilateral conjunctivitis
More key diagnostic factors

Other diagnostic factors

  • rales
  • nonproductive cough/dyspnea
  • systemic toxicity symptoms
  • sore throat
  • photophobia
  • jaundice, hepatosplenomegaly, diarrhea
  • positive Kernig/Brudzinski sign, stiff neck
Other diagnostic factors

Risk factors

  • tick exposure
  • biting fly exposure
  • contact with infected animals
  • yard work in areas where infected animals live
More risk factors

Diagnostic investigations

1st investigations to order

  • serology
  • blood culture
  • specimen culture
  • polymerase chain reaction (PCR) of ulcer swab or lymph node aspirate
More 1st investigations to order

Investigations to consider

  • chest x-ray
  • lumbar puncture
  • histopathology
More investigations to consider

Emerging tests

  • antigen detection in urine

Treatment algorithm

ACUTE

tularemia without meningitis

tularemic meningitis

Contributors

Authors

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

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.

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