What is Tularemia?

Tularemia is a rare infectious disease that can attack your skin, lungs, eyes, and lymph nodes. Sometimes it’s called rabbit fever or deer fly fever. It’s caused by a bacteria called Francisella tularensis.

Causes

People can become sick with tularemia, but it’s not a disease that naturally occurs in humans. It often affects rabbits and other animals including rodents, sheep, and birds. House pets like dogs and cats can get tularemia too.

These are some of the ways people can get it:

• Insect bites, especially from a deer fly or tick
• Coming into contact with the skin, hair, or meat of an animal that’s infected
• Consuming contaminated water or food, such as undercooked meat
• Breathing in bacteria that comes up from the soil during an activity like construction or gardening

It’s also possible to become infected if you’re exposed to the bacteria in a laboratory setting, or potentially, in an act of bioterrorism.

Tularemia can happen anywhere in the world, but it’s most common in rural areas where animals are more likely to be infected with the bacteria. It can survive in soil, water, and dead animals for weeks. That’s why it can cause infections in so many different ways.

The way you become infected with the disease influences the type of symptoms you’ll have and how severe they may be. But just because you’re exposed to the bacteria doesn’t mean you’ll become sick with the disease.

Symptoms

If you do become sick after being exposed to Francisella tularensis, you’re likely to start having symptoms within 3 to 5 days, but it can take up to 2 weeks. There are different types of tularemia that each have their own specific symptoms.

Ulceroglandular tularemia is the most common variety of the disease. Symptoms can include:

• An ulcer on the skin that’s usually caused by a bite from an infected animal or insect
• Lymph glands that are painful and swollen
• Fever
• Chills
• Headache
• Fatigue

Oculoglandular tularemia affects the eyes. Symptoms can include:

• Pain, swelling, or discharge in the eye
• Redness in the eye
• Light sensitivity
• An ulcer that forms inside the eyelid
• Tender lymph glands around the ear, neck, and jaw

Oropharyngeal tularemia affects the mouth, throat, and digestive system. It’s the form of the disease that’s most often caused by eating undercooked meat from a wild animal or drinking water that’s contaminated. Symptoms can include:

• Throat pain
• Vomiting
• Diarrhea
• Swollen tonsils or lymph nodes in the neck
• Ulcers in the mouth
• Fever

Pneumonic tularemia can cause symptoms that are often associated with pneumonia, including:

• Trouble breathing
• Pain in the chest
• A dry cough

Typhoidal tularemia is a rare, but very serious form of the disease. Symptoms can include:

• An enlarged spleen or liver
• Diarrhea and vomiting
• Severe fatigue
• Elevated fever

Who’s at Risk?

Tularemia is rare. There were only 229 reported cases in the United States in 2018. People get it most from tick bites or contact with a contaminated animal.

The following can also increase your risk for developing tularemia:

• Jobs such as laboratory worker, farmer, veterinarian, hunter, landscaper, wildlife manager, and meat handler
• Living in or visiting the south-central United States
• Hunting or gardening. Wild animals may be infected with tularemia, and stirring up soil may cause bacteria to be released.

Diagnosis and Treatment

It can be hard to diagnose tularemia because the symptoms can be similar to other diseases. Your doctor will test you to confirm the bacteria is present. They may also order a chest X-ray to check for signs of pneumonia.

Treatment usually involves antibiotics, either injected or by mouth. If you have complications like pneumonia or meningitis, you’ll also need treatment for these conditions. Usually people who have had tularemia become immune to it, but some people get it more than once.

Prevention

You can protect yourself by:

• Not using bare hands to skin or dress wild animals
• Avoiding sick or dead animals
• Wearing clothing that covers exposed skin (tight at the wrists and ankles)
• Using insect repellents
• Removing ticks promptly
• Drinking clean water
• Fully cooking wild meats

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