Tularemia is a potentially serious illness caused by the bacterium Francisella tularensis found in animals (especially rodents and rabbits). Tularemia is sometimes referred to as deerfly fever or rabbit fever.

In 1911, G. W. McCoy discovered the disease in squirrels in Tulare County, CA. Edward Francis discovered that the deer-fly transmitted the bacteria through infected blood. Tularemia has been reported in all US states except Hawaii.

QUOTE- "He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness.

This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II.

Later, in the United States, voluntary human experimentation occurred in the 1950s-1960s with penitentiary inmates and non-combatant soldiers.

Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-1983." Source

Symptoms of tularemia could include:

sudden fever

enlarged lymph nodes



possible conjunctivitis


muscle aches


joint pain and stiffness

dry cough

progressive weakness

possible red spot on skin forming an ulcer

Additional Symptoms- People can also develop chest pain, bloody sputum and can have trouble breathing and stop breathing. Other symptoms of tularemia can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Complications can include meningitis, osteomyelitis, pericarditis or pneumonia. Symptoms can appear 3 days after exposure to the bacteria, but can take as long as 14 days.

People can be exposed to tularemia several 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 (inhaling) the bacteria

Diseases that can mimic tularemia

  • Ulcero-glandular and glandular fever can be mistaken for cat scratch disease, malignancy, atypical and typical mycobacterial infection, toxoplasmosis, fungal infection, herpes simplex infection, syphilis, bubonic plague, anthrax, and rat-bite fever,
  • Oculoglandular disease can be misdiagnosed as cat scratch disease, herpes simplex, adenovirus infection, or other forms of pyogenic conjunctivitis.
  • Pharyngeal disease can be misdiagnosed as Group A streptococcal pharyngitis, mononucleosis, adenoviral pharyngitis, or diphtheria.
  • Typhoidal disease – in addition to mimicking Salmonella tularemia can be mistaken for brucellosis, Q fever and endocarditis.
  • Pneumonic disease can be mistaken for Q fever, psittacosis, tuberculosis, pneumonic plague, pulmonary fungal infection, as well as community-acquired pneumonia.
  • A failure to respond to conventional antibiotics should raise the possibility of tularemia.



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TREATMENT- People who have been exposed to the tularemia bacteria should be treated as soon as possible with antibiotics. The disease can be fatal, especially if it is not treated with the right antibiotics.

Streptomycin is the drug of choice for the treatment of tularemia. The drug is bactericidal and patients treated with streptomycin usually respond within 48 hours of its administration. Relapses can occur if the drug is given too early in the course of the disease or if is not continued long enough.

Current treatment recommendations are as follows:

Adults: preferred choices are Streptomycin, 1 gm IM twice daily for 10 days or Gentamicin, 5 mg/km IM or IV once daily for 10 days.

Adults: alternative choices are Doxycycline, 100 mg IV twice daily for 14-21 days or Chloramphenicol, 15 mg/kg IV 4 times daily for 14-21 daysor Ciprofloxacin, 400 mg IV twice daily for 10 days.

Children: preferred choices are Streptomycin, 15 mg/kg IM twice daily (maximum daily dose, 2 gm) for 10 days or Gentamicin, 2.5 mg/kg IM or IV 3 times daily for 10 days.

Children: alternative choices are Doxycycline, >45 kg, give adult dosage for 14-21 days <45 kg, give 2.2 mg/kg IV twice daily for 14 - 21 days or Ciprofloxacin, 15 mg/kg IV twice daily for 10 days (maximum daily dose, 1 gm) or Chloramphenicol, 15 mg/kg IV 4 times daily for 14 - 21 days (maximum daily dose, 4 gm).


Tularemia- What You Need To Know

IGeneX Lab Article

Oxf Med Case Reports. 2018 Aug 25;2018(9):omy067. doi: 10.1093/omcr/omy067. eCollection 2018 Sep.

Francisella tularensis bacteraemia causing multi-organ failure.

Hansen BA1, Tilseth R2, Finjord T2, Bruserud Ø3.

Tularemia is a zoonosis caused by the gram-negative coccobacillus Francisella tularensis. The bacterium can be transmitted in several ways including direct contact with animal reservoirs, ingestion, inhalation and bites, and typical clinical symptoms are headache, fever, diarrhea and dyspnea. Francisella tularensis has two predominant subspecies (ssp), namely ssp. tularensisand ssp. holarctica. Ssp. holarctica is less virulent and does usually not cause fatal disease.

We here present a 51-year-old male with sepsis and multi-organ failure caused by F. tularensis ssp. holarctica infection suggesting that atypical agents including F. tularensis should be considered in patients presenting symptoms of infections without response to standard treatments.

Free PMC Article

Link Here- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109193/

Last Updated- December 2019

Lucy Barnes