Tularemia

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Last reviewed: June 2019

Last updated: August 2018

Summary

Spread by ticks, biting flies, direct contact with infected animals or animal skin, or inhalation of aerosols when doing yard 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 serologic 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

An infectious disease caused by the gram-negative bacteria Francisella tularensis . 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 yard work (e.g., mowing the lawn) where infected animals live.

History and exam

Key diagnostic factors

spring or summer season
fever
localized unilateral lymphadenopathy
painful skin ulcer
unilateral conjunctivitis

Full details

Other diagnostic factors

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

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Risk factors

tick exposure
biting fly exposure
contact with infected animals
yard work in areas where infected animals live

Full details

Diagnostic investigations

1st investigations to order

serology
blood culture
specimen culture
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

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Treatment algorithm

ACUTE

tularemia: no meningitis

tularemic meningitis

Contributors

Authors VIEW ALL 

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 VIEW ALL 

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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