Tularemia
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals (especially rodents, rabbits, and hares).
People can get tularemia many different ways, such as through the bite of an infected insect or other arthropod (usually a tick or deerfly), handling infected animal carcasses, eating or drinking contaminated food or water, or breathing in F. tularensis.
Symptoms of tularemia could include sudden fever, chills, headaches, muscle aches, joint pain, dry cough, progressive weakness, and pneumonia. Persons with pneumonia can develop chest pain, bloody spit, and may have trouble breathing or can sometimes stop breathing. Other symptoms of tularemia depend on how a person was exposed to the tularemia bacteria. These symptoms can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Symptoms usually appear 3 to 5 days after exposure to the bacteria but can take as long as 14 days.
Tularemia is not known to be spread from person to person, so people who have tularemia do not need to be isolated.
A vaccine for tularemia is under review by the Food and Drug Administration and is not currently available in the United States.
How do people become infected with the tularemia bacteria?
Typically, people become infected through the bites of arthropods (most commonly, ticks and deerflies) that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking contaminated food or water, or by inhaling infected aerosols.
Does tularemia occur naturally in the United States?
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infected ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.
Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.
Can tularemia be effectively treated with antibiotics?
Yes. After potential exposure or diagnosis, early treatment is recommended with an oral antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.
Healthcare Worker and Provider FAQ
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.
Francisella tularensis is highly infectious: a small number of bacteria (10-50 organisms) can cause disease. If F. tularensis were used as a bioweapon, the bacteria would likely be made airborne for exposure by inhalation. Persons who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they were not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.
The incubation period for tularemia is typically 3 to 5 days, with a range of 1 to 14 days.
Seek prompt medical attention. If a person has been exposed to Francisella tularensis, treatment with tetracycline antibiotics for 14 days after exposure may be recommended.
Local and state health departments should be immediately notified so investigation and control activities can begin quickly. If the exposure is thought to be due to criminal activity (bioterrorism), local and state health departments will notify the CDC, FBI, and other appropriate authorities.
When tularemia is clinically suspected, the healthcare worker will collect specimens, such as blood or sputum, from the patient for testing in a diagnostic or reference laboratory. Laboratory test results for tularemia may be presumptive or confirmatory. Presumptive (preliminary) identification may take less than 2 hours, but confirmatory testing will take longer, usually 24 to 48 hours.
Yes. After potential exposure or diagnosis, early treatment is recommended with an oral antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.
Francisella tularensis can remain alive for weeks in water and soil.
In the past, a vaccine for tularemia has been used to protect laboratory workers, but it is currently under review by the Food and Drug Administration.