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Tularemia (Francisella tularensis)
1990 Case Definition

Clinical Description

An illness characterized by several distinct forms, including:

  • Ulceroglandular: cutaneous ulcer with regional lymphadenopathy
  • Glandular: regional lymphadenopathy with no ulcer
  • Oculoglandular: conjunctivitis with preauricular lymphadenopathy
  • Intestinal: pharyngitis, intestinal pain, vomiting, and diarrhea
  • Pneumonic: primary pleuropulmonary disease
  • Typhoidal: febrile illness without early localizing signs and symptoms
Clinical diagnosis is supported by evidence or history of a tick or deerfly bite, exposure to tissues of a mammalian host of Francisella tularensis, or exposure to potentially contaminated water.

Laboratory Criteria for Diagnosis

  • Isolation of F. tularensis from a clinical specimen, OR
  • Demonstration of F. tularensis in a clinical specimen by immunofluorescence, OR
  • Fourfold or greater rise in agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart, analyzed at the same time, and in the same laboratory

Case Classification


A clinically compatible case with supportive serologic results (tularemia agglutination titer of greater than or equal to 160 in one or more serum specimens obtained after onset of symptoms)


A case that is laboratory confirmed