Last reviewed: 30 Oct 2023
Last updated: 09 Jun 2023
Summary
Definition
History and exam
Key diagnostic factors
- fever
- lymphadenopathy
- painful skin ulcer
- unilateral conjunctivitis
More key diagnostic factors
Other diagnostic factors
- headache
- malaise/fatigue
- myalgia
- anorexia
- abdominal pain
- vomiting
- rales
- nonproductive cough/dyspnea
- sore throat
- photophobia
- vision impairment/loss
- 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
- spring or summer season
More risk factors
Diagnostic investigations
1st investigations to order
- CBC
- 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
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
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
- Tularemic bacteremia
- Cat scratch disease
- Toxoplasmosis
More DifferentialsGuidelines
- Tickborne diseases of the United States: a reference manual for health care providers
- Practice guidelines for the diagnosis and management of skin and soft tissue infections
More Guidelines
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