Tularemia is a rare bacterial infection. The effects of the infection will depend on where the exposure occurs. It can be deadly if not treated.
Tularemia is caused by specific bacteria. It is normally found in small animals, such as mice and rabbits. The bacteria can pass to humans through: Bites of infected animals, ticks, or deer flies.Contact with an infected animal's tissues or contaminated water, food, or soil. Can enter the body through the lungs, eyes, mouth, nose, or skin.
The infection does not pass between people.
Factors that increase your risk of tularemia include: Hunting, trapping, or butchering infected animalsWorking with infected animals or their tissueWorking in a laboratory with the bacteriaBiological terrorismEating meat from an infected animalBeing bitten by an infected mosquito or tick
Symptoms usually occur 3-5 days after exposure. The symptoms will depend on where the bacteria entered the body, the type and amount of bacteria you were exposed to, and your immune system.
Pneumonic symptoms (lung problems): FeverChillsFatigueHeadacheBody achesSore throatCoughBurning sensation or pain in chest
Ulceroglandular symptoms (skin and lymph gland problems): Raised, red bump that continues to swellRaised area opens, drains pus, and forms an ulcerMay form a dark scabSwollen, tender lymph nodesFeverChills
Glandular symptoms (problems in lymph nodes): Swollen, tender lymph nodes, but not sore
Oculoglandular symptoms (problems in eyes and lymph nodes): Sensitivity to lightTearingPuffy eyelidSwelling, redness, and sores in the eyeSwollen lymph nodes
Oropharyngeal symptoms (mouth and throat problems): Irritated membranes in the mouthSore throatUlcers in the throat or on tonsilsSwollen lymph nodes
Intestinal symptoms: FeverAbdominal painDiarrheaVomiting
Typhoidal symptoms (full body problems): FeverChillsHeadacheMuscle achesPoor appetiteNauseaVomitingDiarrheaAbdominal painCough
Symptoms of progression from other types: Swollen lymph nodesDifficulty breathingBleedingConfusionComaOrgan failureShockDeath
Swollen Lymph Nodes
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The doctor will ask about your symptoms and medical history. You will be asked about possible sources of exposure. A physical exam will also be done.
Your doctor may look for signs of the infection through: Examining body fluidsCulture of body fluids—to check for bacteriaSkin test to check for an immune responseBlood test—to detect antibodies to the bacteria
may also be done if there are problems with your lungs.
Antibiotics can treat most tularemia infections. The first few doses of antibiotics will be injected in a muscle or given through a vein. You may need to take antibiotics by mouth for a few days after the initial dose. Treatment can last for 10-14 days. Make sure to take all of your medication even if you feel better.
Tularemia infections are reported to public health officials. This will help them track any outbreaks.
Measures to prevent the disease include: Do not handle sick or dead animals.Wear gloves, mask, and goggles if skinning or butchering animals.Completely cook game meats.
Take precautions if you live in an area with ticks or deer flies:
Wear protective clothing.Use tick repellant.Check skin often for ticks.Do not touch a tick with your hand.Follow precautions when working in a laboratory.
AAP Red Book: Report of the Committee on Infectious Diseases. 27th ed. American Academy of Pediatrics; 2006.
Cecil Textbook of Medicine. 22nd ed. WB Saunders Company; 2004.
Centers for Disease Control and Prevention (CDC) website. Available at:
http://emergency.cdc.gov/agent/tularemia/. Updated January 11, 2011. Accessed November 12, 2012.
Griffith's 5-Minute Clinical Consult. 2006 ed. Lippincott Williams & Wilkins; 2005.
Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone Inc.; 2004.
Tularemia. Illinois Department of Public Health website. Available at:
http://www.idph.state.il.us/public/hb/hbtulare.htm. Accessed November 12, 2012.
Tularemia. US Army Center for Health Promotion and preventive Medicine website. Available at:
http://phc.amedd.army.mil/PHC%20Resource%20Library/18-006-0406-Tularemia-JusttheFactsApril2006.pdf. Updated April 2006. Accessed November 12, 2012.
Last reviewed December 2013 by David L Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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