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Clinical manifestations, diagnosis, and treatment of tularemia

Robert L Penn, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Allyson Bloom, MD


Tularemia is the zoonotic infection caused by Francisella tularensis, an aerobic and fastidious gram-negative bacterium. Human infection occurs following contact with infected animals or invertebrate vectors. The clinical manifestations from Francisella infection may range from asymptomatic illness to septic shock and death, in part depending on the virulence of the infecting strain, portal of entry, inoculum, and the immune status of the host [1].

The clinical manifestations, diagnosis, treatment, and prevention of tularemia will be reviewed here. The microbiology, pathogenesis, and epidemiology of infection due to F. tularensis are discussed separately. (See "Epidemiology, microbiology, and pathogenesis of tularemia".)


The average incubation period following infection with F. tularensis is 3 to 5 days (range 1 to 21 days). Tularemia usually has an abrupt or rapid onset of nonspecific systemic symptoms, including some combination of fever, chills, anorexia, and malaise. Patients also may complain of headache, fatigue, soreness in the chest or muscles, abdominal pain, emesis, or diarrhea. Classically the fever may abate after a few days but then quickly return.

Additional signs and symptoms develop depending on the portal of entry; when patients come to medical attention, they usually have at least one of the six major clinical forms of tularemia [2]:

Ulceroglandular tularemia

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Literature review current through: Nov 2017. | This topic last updated: May 27, 2016.
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