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Tularemia

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 8 Aug 2025
Last updated: 09 Jun 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • febre
  • linfadenopatia
  • úlceras cutâneas dolorosas
  • conjuntivite unilateral
Full details

Other diagnostic factors

  • cefaleia
  • mal-estar/fadiga
  • mialgia
  • anorexia
  • dor abdominal
  • vômitos
  • estertores
  • tosse não produtiva/dispneia
  • faringite
  • fotofobia
  • comprometimento/perda da visão
  • icterícia, hepatoesplenomegalia, diarreia
  • sinal de Brudzinski/Kernig positivo, rigidez no pescoço
Full details

Risk factors

  • exposição ao carrapato
  • exposição à picada de mosca
  • contato com animais infectados
  • trabalho em ambientes externos onde vivem animais infectados
  • primavera ou verão
Full details

Diagnostic tests

1st tests to order

  • Hemograma completo
  • níveis de eletrólitos séricos
  • TFHs
  • creatina quinase sérica
  • tira reagente para exame de urina para sangue
  • velocidade de hemossedimentação
  • sorologia
  • hemocultura
  • cultura de espécime
  • reação em cadeia da polimerase de swab de úlcera ou aspirado de linfonodo
Full details

Tests to consider

  • radiografia torácica
  • punção lombar
  • histopatologia
Full details

Emerging tests

  • detecção do antígeno na urina

Treatment algorithm

ACUTE

tularemia sem meningite

meningite tularêmica

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers, sixth edition. Aug 2022 [internet publication].Full text

World Health Organization (WHO). WHO Guidelines on tularaemia. 2007 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Tularemia images

  • Differentials

    • Bacteremia tularêmica
    • Doença por arranhadura do gato
    • Toxoplasmose
    More Differentials

  • Guidelines

    • Tickborne diseases of the United States: a reference manual for health care providers
    • Tularaemia control guideline
    More Guidelines
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