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Overview

What Is Tularemia?

Tularemia is a bacterial disease caused by Francisella tularensis. It can affect people and many animals, especially rabbits, rodents and other wildlife. People commonly become infected through tick or deer-fly bites, contact with infected animals, contaminated water or soil, inhalation of contaminated particles, or eating undercooked infected meat. Person-to-person spread is not the usual way tularemia disease is transmitted.

Symptoms

Tularemia Symptoms

Tularemia symptoms often begin suddenly, with fever developing several days after exposure. The symptoms can vary depending on whether the bacteria enter through the skin, eyes, mouth, lungs or digestive tract. Tell a healthcare professional about a possible tularemia tick bite or animal exposure, even if the exposure happened several days earlier.

  • Fever
  • Chills
  • Headache
  • Muscle aches (myalgia)
  • Fatigue
  • Swollen lymph nodes (lymphadenopathy)
  • A skin ulcer at the entry site
  • Sore throat
  • Eye inflammation (conjunctivitis)
  • Cough
  • Chest discomfort
  • Vomiting or diarrhea

How It Spreads

How Tularemia Spreads

Tularemia is caused by Francisella tularensis and is usually acquired from infected animals, arthropod bites or contaminated environments. Exposure can occur through broken skin, the eyes, the mouth or the lungs. Routine person-to-person contact does not usually spread the infection.

  • A tick or deer-fly bite can transmit the bacteria, including a tularemia infection from a tick.
  • Handling infected rabbits or rodents can expose a person through the skin, eyes or mouth.
  • Contact with an infected pet, such as a dog or cat, can spread bacteria carried from wildlife or ticks.
  • Contaminated water or soil can infect people through drinking, contact with broken skin or accidental exposure.
  • Inhaling contaminated particles can cause respiratory tularemia.
  • Eating inadequately cooked infected game meat can transmit the infection.

ANIMAL EXPOSURE

Handle wildlife carefully

Use gloves when handling sick or dead rabbits, rodents or other wildlife, and wash your hands afterward. If a dog or cat may have had wildlife or tick exposure, keep your distance from potentially contaminated materials and seek veterinary advice.

Risk Factors

Tularemia Risk Factors

  • Living or working in an area where tularemia occurs can increase exposure risk.
  • Frequent tick exposure raises the chance of infection.
  • Hunting, skinning or dressing rabbits can expose a person to infected tissues.
  • Landscaping, mowing or brush work can disturb contaminated soil or plant material.
  • Veterinary, wildlife-control or animal-care work can involve infected animals.
  • Laboratory work with Francisella tularensis can cause occupational exposure.
  • Drinking untreated surface water can expose a person to contaminated water.
  • Contact with infected pets or wildlife can transmit bacteria through bites, scratches or contaminated materials.

Complications

Tularemia Complications

Complications are uncommon when tularemia is recognized and treated promptly. Delayed treatment or severe infection can cause prolonged illness and affect the lungs, nervous system, bloodstream or other organs.

  • Pneumonia can develop when infection affects the lungs.
  • Respiratory failure can occur in severe pulmonary disease.
  • Meningitis is a serious infection involving the coverings of the brain and spinal cord.
  • Sepsis can occur when the infection causes a dangerous whole-body response.
  • Infection of the heart lining or valves can affect heart function.
  • Bone infection (osteomyelitis) is a rare possible complication.
  • Persistent or recurrent infection can occur if disease is severe or treatment is incomplete.

GET URGENT HELP

Recognize serious illness

Seek urgent medical evaluation for breathing difficulty, confusion, severe weakness, fainting or rapidly worsening illness after a possible tularemia exposure.

Diagnosis

Diagnosis of Tularemia

Clinicians consider tularemia when fever or a characteristic ulcer, swollen lymph nodes, eye findings, throat symptoms or pneumonia follows a relevant tick, animal, water, soil or inhalation exposure. Because the illness can resemble other infections, the exposure history is an important part of diagnosis.

  • A medical and exposure history identifies tick bites, animal contact, environmental exposure and symptom timing.
  • A physical examination checks the skin, lymph nodes, eyes, throat, lungs and other affected areas.
  • Blood antibody testing can help confirm infection, although antibodies may not be detectable early in illness.
  • Molecular testing or culture of an appropriate specimen may be performed by a laboratory that has been alerted to the suspected diagnosis.

Treatment & Management

Tularemia Treatment and Management

Tularemia requires prescription antibiotics. Clinicians choose the medication, route and duration based on the form and severity of illness, age, pregnancy status and other medical factors. Prompt clinician-directed tularemia treatment can reduce the risk of complications.

  • Clinician-directed antibiotic therapy treats the infection and should be taken exactly as prescribed.
  • Hospital care may be needed for severe or inhalational disease.
  • Fluids and fever control can support recovery when needed.
  • Monitoring helps clinicians identify complications or a lack of improvement.
  • Completing the prescribed course helps reduce the risk of persistent or recurrent infection.

TREATMENT SAFETY

Use antibiotics only as directed

Do not self-treat with leftover antibiotics. Tell the clinician about any tick bite, wildlife contact, animal illness, occupational exposure or possible inhalation exposure so treatment can be selected safely.

Prevention

Tularemia Prevention

  • Use insect repellent and wear protective clothing in areas where ticks or deer flies may be present.
  • Check your skin, clothing and pets for ticks and remove attached ticks promptly.
  • Wear gloves when handling rabbits, rodents or other wildlife.
  • Cook game meat thoroughly before eating it.
  • Avoid drinking untreated surface water.
  • Use precautions such as gloves and appropriate clothing during landscaping, mowing or brush work.

Outlook and Prognosis

Tularemia Outlook and Prognosis

Most people recover from tularemia with timely, appropriate antibiotic treatment. Untreated or severe tularemia can lead to prolonged illness, hospitalization or serious complications. Early medical evaluation is especially important after a relevant tick, animal or environmental exposure.

  • The tularemia form can affect the symptoms, treatment needs and recovery.
  • The exposure route, such as inhalation or a skin entry site, can influence severity.
  • Overall illness severity affects the expected recovery course.
  • The time to treatment matters because delayed treatment can increase complications.
  • Underlying health conditions may affect recovery and the need for monitoring.
  • Pneumonia or other complications can make recovery longer and more complex.

When Should You See a Doctor

When Should You See a Doctor?

SEEK MEDICAL ADVICE

Get evaluated after a possible exposure

Contact a healthcare professional promptly for fever, an unexplained skin ulcer, swollen lymph nodes, eye inflammation, sore throat or breathing symptoms after a tick bite, animal contact, untreated water exposure or possible inhalation exposure.

EMERGENCY SYMPTOMS

Seek emergency care

Call emergency services or go to an emergency department for severe breathing difficulty, confusion, fainting, bluish lips or rapidly worsening illness.

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