Tularemia: Risk Factors, Causes, and Symptoms (2024)

Tularemia is an infectious disease that typically infects the following animals:

  • wild rodents
  • squirrels
  • birds
  • rabbits

The disease is caused by the bacterium Francisella tularensis. It can be life threatening.

Read on to find out how tularemia is transmitted to humans, the different forms of the disease and their symptoms, treatment options, and more.

Humans can contract tularemia by having direct contact with an infected animal or from tick, mosquito, or deer fly bites.

The various forms of tularemia are distinguished by where the bacteria enter a person’s body.

The most common form of the disease is caused by skin contact with the bacteria. The most severe form of the disease is caused by inhaling the bacteria.

Tularemia can often be treated with antibiotics. Early treatment offers a good outlook for complete recovery. However, some severe cases may be fatal even with treatment.

Tularemia is rare. There are usually 100 to 200 new cases reported in the United States each year.

The symptoms of tularemia can vary greatly, from asymptomatic or mild to life threatening. Symptoms typically appear within 3 to 5 days of being infected with the bacteria, but in some cases can take up to 2 weeks to appear.

Symptoms can also vary depending on where the bacteria enters a person’s body. Here are some of the forms of tularemia and their associated symptoms.

Ulceroglandular tularemia

The symptoms of ulceroglandular tularemia, or infection through the skin, can include:

  • a skin ulcer at the point of contact with the infected animal or at the site of a bite
  • swollen lymph nodes near the skin ulcer (most often in the armpit or groin)
  • severe headaches
  • a fever
  • chills
  • fatigue

Glandular tularemia

The symptoms of glandular tularemia, or infection through the skin, are similar to ulceroglandular symptoms but without a skin ulcer.

Pneumonic tularemia

Pneumonic tularemia is the most serious form of this disease. It’s transmitted through inhalation. The symptoms can include:

  • a dry cough
  • breathing difficulty
  • a high fever
  • chest pain

Oculoglandular tularemia

The symptoms of oculoglandular tularemia, or infection of the eye, can include:

  • eye irritation
  • eye pain
  • eye swelling
  • discharge or redness of the eye
  • a sore on the inside of the eyelid
  • swollen lymph glands behind the ear

Oropharyngeal tularemia

The symptoms of oropharyngeal tularemia, or infection through ingestion of the bacteria, can include:

  • a sore throat
  • ulcers in the mouth
  • swollen lymph nodes in the neck
  • tonsillitis, or swollen tonsils
  • vomiting
  • diarrhea

Typhoidal tularemia

The symptoms of the rarest form of this disease, typhoidal tularemia, can include:

  • a very high fever
  • extreme fatigue
  • diarrhea
  • vomiting

Typhoidal tularemia can lead to pneumonia and an enlarged liver and spleen.

Severe and untreated cases of tularemia may cause the following complications:

  • chronic heart failure
  • swelling of the membranes that surround your brain and spinal cord, which is called meningitis
  • death

The bacterium Francisella tularensis causes tularemia. Creatures capable of carrying the bacteria include:

  • rabbit and deer ticks
  • deerflies
  • hares
  • rabbits
  • rodents
  • pets that go outdoors

Which type of tularemia you develop depends on how the bacteria enters your body.

Skin exposure is the most common form of the disease. Inhalation through the lungs is the most serious form of tularemia.

If it’s left untreated, other forms of the disease may eventually reach the following areas of the body:

  • lungs
  • spinal cord
  • brain
  • heart

The disease can cause serious complications and sometimes death.

The route of entry and resulting forms of tularemia include the following:

  • Skin exposure causes glandular or ulceroglandular tularemia.
  • Inhalation of aerosolized bacteria causes pneumonic tularemia.
  • Exposure through the eye causes oculoglandular tularemia.
  • Ingestion causes oropharyngeal tularemia.
  • Systemic infection (one that affects the entire body) causes typhoidal tularemia.

Animals carry the bacteria that causes tularemia. You’re at increased risk of getting the disease if you have frequent contact with animals.

People at an increased risk for tularemia include those who:

  • work closely with animals, such as veterinarians, zookeepers, and park rangers
  • live in heavily forested areas
  • work with animal carcasses, such as hunters, taxidermists, and butchers
  • work in gardening and landscaping

Diagnosing tularemia isn’t easy because it can often appear like other diseases. The various possible routes of entry of the bacterium complicates the issue.

Your doctor must rely heavily on a your personal and medical history to help diagnose you.

Your doctor may suspect tularemia if you’ve had recent travels, insect bites, or contact with animals. They may also suspect that you have this disease if you already have a serious medical condition that compromises your immune system, such as cancer or HIV.

Your doctor can use a serology test to detect tularemia. This test looks for specific antibodies that your body has created to fight the infection.

Because early testing may not always detect antibodies, your doctor may also want to collect a sample to culture in a lab. Samples can be taken from:

  • skin
  • lymph nodes
  • pleural fluid (the fluid from the pleurae in the chest cavity)
  • spinal fluid

Each case of tularemia is treated according to its form and severity. Early diagnosis allows for immediate treatment with antibiotics.

Antibiotics that may be used to treat tularemia include:

Surgical intervention may be required to drain swollen lymph nodes or to cut away infected tissue from a skin ulcer. You may also be given medications for fever or headache symptoms.

Prevention involves taking basic safety precautions. The bacteria thrive in dirty conditions. Outbreaks of this disease have occurred in hunting parties when hunters failed to practice safe cleaning methods and contaminated their belongings.

To safely clean animals when hunting, you should take the following precautions:

  • Don’t skin or dress (remove the organs of) any animal that appears to be sick.
  • Wear gloves and goggles when handling any animal.
  • Wash your hands carefully after handling an animal.
  • Cook the meat thoroughly.

Here are a few tips for decreasing your overall risk of contracting tularemia:

  • Wear long pants and sleeves in the forest to help prevent tick bites.
  • Keep animal remains away from food or water.
  • Avoid drinking water from lakes or ponds.
  • Protect your outdoor pets with flea and tick medicines.
  • Use insect repellents.

Tularemia is easily aerosolized. Because of this, it can potentially be a deadly bioterrorism agent according to the Centers for Disease Control and Prevention (CDC). However, you’re much more likely to become infected from contact with an animal.

You should talk to your doctor immediately if you think you might have tularemia.

Your outlook for tularemia depends on the severity of the condition and how quickly you start receiving treatment. Hospitalization is common in many cases.

If you think you have tularemia, see your doctor right away. Delays in diagnosis will cause a worsening of symptoms.

Tularemia: Risk Factors, Causes, and Symptoms (2024)


What are the risk factors for tularemia? ›

People can get tularemia many different ways:
  • being bitten by an infected tick, deerfly or other insect.
  • handling infected animal carcasses.
  • eating or drinking contaminated food or water.
  • breathing in the bacteria, F. tularensis.

Which of the following causes the symptoms of tularemia? ›

Tularemia is an illness you get from the bacterium Francisella tularensis (F. tularensis). It causes your lymph nodes to painfully swell and other symptoms in your lungs, eyes, throat and intestines, depending on where the bacteria infects you.

Who is at greatest risk of contracting tularemia? ›

Who is at highest risk for getting tularemia? Veterinarians, hunters, trappers, landscapers, farmers, and people who spend time outdoors where ticks and biting flies are common are at higher risk for acquiring tularemia.

What causes tularemia in animals? ›

Tularemia (also known as rabbit fever) is caused by the bacterium Francisella tularensis.

Who is most affected by tularemia? ›

Tularemia is a disease that can infect animals and people. Rabbits, hares, and rodents are especially susceptible and often die in large numbers during outbreaks.

What are the chances of getting tularemia? ›

Tularemia is rare. There are only about 200 cases reported each year in the United States. People get it most from tick bites or contact with a contaminated animal.

How do I know if I have tularemia? ›

Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck. Pneumonic This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism.

Can tularemia go away on its own? ›

There are no home remedies for tularemia. It is a relatively rare disease but can quickly become fatal (60% of individuals infected may die from it) if not treated with appropriate antimicrobials.

How to prevent tularemia? ›

Avoid contact with wild rodents, rabbits and hares; do not feed or handle them. If an animal carcass must be moved, place it in a garbage bag using a long-handled shovel, and place the bag in an outdoor garbage can. Prevent insect bites; use insect repellent containing DEET on your skin, or treat clothing with insect.

Is tularemia caused by soft or hard ticks? ›

In both North America and Europe, most common vectors of F. tularensis subsp. holarctica are hard ticks (Ixodidae) followed by biting flies and mosquitoes.

Is tularemia killed by cooking? ›

Can I eat the meat? Normal cooking temperatures kill bacteria in the meat. Therefore, it is safe to eat. However, human exposure typically occurs while gutting a hare.

Is tularemia itchy? ›

A discharge may be present, and the ulcer may be covered by an eschar (scab) and/or be itchy. Over weeks to months the ulcer heals and is replaced by scar tissue. The primary lesion caused by type B tularaemia infection may be less severe, e.g. crusting, but no ulcer.

What is the chain of infection for tularemia? ›

In ulceroglandular tularemia, the organism is acquired through the skin via arthropod bite or abrasion. Usually, the vector is a tick, but deer flies and mosquitoes can also transmit F. tularensis. A skin ulcer develops at the site of infection.

What happens if tularemia is left untreated? ›

Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.

What is the main vector of tularemia? ›

tularensis is commonly transmitted by ticks and by tabanid flies, whereas Type B strain is commonly transmitted by ticks, blood-feeding mosquitoes, and by tabanid flies. In USA, bites by ticks are the predominant mode of tularemia transmission.

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