Highlights & Basics
- Tularemia is 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
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]
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2. Guffey MB, Dalzell A, Kelly DR, et al. Ulceroglandular tularemia in a nonendemic area. South Med J. 2007 Mar;100(3):304-8.[Abstract]
3. Weiner E, Stryjewski G, Eppes S. Variable presentation of the cause of lymphadenopathy in two children. Pediatr Infect Dis J. 2004 Oct;23(10):972-3.[Abstract][Full Text]
4. Hornick R. Tularemia revisited. N Engl J Med. 2001 Nov 29;345(22):1637-9.[Abstract][Full Text]
5. Arav-Boger R. Cat-bite tularemia in a seventeen-year-old girl treated with ciprofloxacin. Pediatr Infect Dis J. 2000 Jun;19(6):583-4.[Abstract][Full Text]
6. Johansson A, Berglund L, Gothefors L, et al. Ciprofloxacin for treatment of tularemia in children. Pediatr Infect Dis J. 2000 May;19(5):449-53.[Abstract]
7. Bellido-Casado J, Pérez-Castrillón JL, Bachiller-Luque P, et al. Report on five cases of tularaemic pneumonia in a tularaemia outbreak in Spain. Eur J Clin Microbiol Infect Dis. 2000 Mar;19(3):218-20.[Abstract]
8. Feldman KA, Enscore RE, Lathrop SL, et al. An outbreak of primary pneumonic tularemia on Martha's Vineyard. N Engl J Med. 2001 Nov 29;345(22):1601-6.[Abstract][Full Text]
9. Rodgers BL, Duffield RP, Taylor T, et al. Tularemic meningitis. Pediatr Infect Dis J. 1998 May;17(5):439-41.[Abstract][Full Text]
10. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2001. A 25-year-old woman with fever and abnormal liver function. N Engl J Med. 2001 Jul 19;345(3):201-5.[Abstract]
11. Thomas LD, Schaffner W. Tularemia pneumonia. Infect Dis Clin North Am. 2010;24:43-55.[Abstract]
12. van de Beek D, Steckelberg JM, Marshall WF, et al. Tularemia with brain abscesses. Neurology. 2007;68:531.[Abstract]
13. Centers for Disease Control and Prevention. Tularemia - statistics. Nov 2022 [internet publication].[Full Text]
14. Pedati C, House J, Hancock-Allen J, et al. Notes from the field: increase in human cases of tularemia - Colorado, Nebraska, South Dakota, and Wyoming, January-September 2015. MMWR Morb Mortal Wkly Rep.2015;64:1317-8.[Abstract][Full Text]
15. 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]
16. Centers for Disease Control and Prevention. Tularemia - transmission. Dec 2018 [internet publication].[Full Text]
17. World Health Organization (WHO). WHO Guidelines on tularaemia. 2007 [internet publication].[Full Text]
18. Mulligan MJ, Stapleton JT, Keitel WA, et al. Tularemia vaccine: safety, reactogenicity, "Take" skin reactions, and antibody responses following vaccination with a new lot of the Francisella tularensis live vaccine strain - a phase 2 randomized clinical trial. Vaccine. 2017 Aug 24;35(36):4730-7.[Abstract]
19. Centers for Disease Control and Prevention. Tularemia: for clinicians. Jul 2022 [internet publication].[Abstract][Full Text]
20. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e10-e52.[Abstract][Full Text]
21. Centers for Disease Control and Prevention: research on doxycycline and tooth staining. Feb 2019 [internet publication].[Full Text]
22. Todd SR, Dahlgren FS, Traeger MS, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever. J Pediatr. 2015 May;166(5):1246-51.[Abstract][Full Text]
23. Kaiser AB, Rieves D, Price AH, et al. Tularemia and rhabdomyolysis. JAMA. 1985 Jan 11;253(2):241-3.[Abstract]
24. Kubiliute I, Zablockiene B, Paulauskiene R, et al. A rare case of tularemia complicated by rhabdomyolysis with a successful outcome. Medicina (Kaunas). 2021 May 5;57(5):449.[Abstract][Full Text]
25. Khoury JK, Khoury NC, Schaefer D, et al. A tick-acquired red meat allergy. Am J Emerg Med. 2018 Feb;36(2):341.e1-3.[Abstract]
26. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust. 2018 Apr 16;208(7):316-21.[Abstract]
27. Pattanaik D, Lieberman P, Lieberman J, et al. "The changing face of anaphylaxis in adults and adolescents". Ann Allergy Asthma Immunol. 2018 Jul 20. pii: S1081-1206(18)30580-5.[Abstract]
