The Center for Acute Disease Epidemiology (CADE)

Symptoms of tularemia appear between three to five days after exposure to the bacteria but can take as long as 14 days. There are at least six types of clinical symptoms, depending on the route of infection and the strain of bacteria.

Ulceroglandular: Patients have large, tender lymph nodes and a non-healing skin ulcer at the site of infection, often with fatigue, chills, and malaise.

Glandular: Patients have one or more enlarged painful nodes that may be filled with pus.

Pneumonic (pulmonary): This may be a primary infection following inhalation of the organisms or secondary to blood infection; with symptoms that may include a non-productive cough, difficulty breathing and chest pain.

Typhoidal: This is a rare form, with enlarged and inflamed lymph nodes, blood poisoning, abdominal pain, diarrhea, vomiting and gastrointestinal bleeding.

Oropharyngeal: This form results from ingestion of bacteria in food or water leading to painful sore throat (pharyngitis), abdominal pain, diarrhea, and vomiting.

Oculoglandular: Patients have eye pain, redness, and discharge with enlarged lymph nodes of the neck or near the ears and usually accompanied with fever, chills and malaise.

Tularemia is caused by the bacteria Francisella tularensis. People may become infected through the following methods:

• Handling infected animals or their carcasses (i.e., hunters while skinning the animal)
• Bites of infected flies, mosquitoes, or ticks
• Contact with infected animals such as rabbits, hares, rodents, or birds (although it is not usually transmitted through the bite of an infected animal)
• Ingesting undercooked infected meat
• Drinking contaminated water
• Inhalation of dust from contaminated soil, grain, or hay

This disease does not spread from person to person.

People who spend a lot of time outdoors or hunt or trap wild animals are at risk for being infected. Gardeners and landscapers are also at risk if they inhale bacteria stirred up when soil is disturbed.

The following precautions should be observed to prevent infection with tularemia:

• wear rubber gloves when skinning or handling wild animals, especially rabbits
• cook wild rabbit and rodent meat completely before eating
• use insect and tick repellents and wear long sleeves and pants when outdoor for long periods of time to avoid tick bites
• during the spring and summer, check yourself for attached ticks every two to three hours when spending time outside and remove any attached ticks immediately
• avoid swimming, drinking, or bathing in untreated water in areas where tularemia infections are prevalent in wild animals

Laboratory employees who work with this bacterium should take the following precautions:

• Wear a face mask, gown, and impervious gloves when working with the organism
• Conduct all procedures using the organism in a negative pressure microbiological cabinet

Tularemia is treated with antibiotics. When treated promptly and appropriately, most people fully recover. If you suspect you have been exposed, seek treatment from your healthcare provider immediately.