Last reviewed: 27 Dec 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

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
- Tularemia: reporting and surveillance guidelines
- Tularemia: reporting and surveillance guidelines
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