Table 1:

Overview of tularemia (1) (4), (7)

ConsiderationKey point
PathogenFrancisella tularensis subspecies tularensis and subspecies holarctica
Relevant exposuresTick or deerfly bite, contact with an infected animal, ingestion of contaminated food or water, occupational exposure (e.g., farmers, hunters, veterinarians, landscapers, meat handlers and laboratory workers), travel or area of residence (typically occurs as a rural disease)
Incubation periodAverage of 3–5 d, range of 1–21 d
SeasonalityMost commonly acquired during the summer months
Classic clinical syndromesUlceroglandular (most common), glandular, oculoglandular, pharyngeal, typhoidal, pneumonic
Diagnostic criteriaConfirmed case
  • Compatible clinical presentation and either recovery of F. tularensis on culture from an appropriate clinical specimen or a fourfold or greater change in F. tularensis serum antibody titres

Probable case
  • Compatible clinical presentation and one of the following: detection of F. tularensis in a clinical specimen by a fluorescent assay, a single serum sample (serology) with a microagglutination titre of ≥ 1:128 or a tube agglutination titre of ≥ 1:160, or detection of F. tularensis nucleic acid with a molecular assay

TreatmentSevere disease
  • Gentamicin or streptomycin

Mild-to-moderate disease
  • Ciprofloxacin or doxycycline