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Tularemia (Francisella tularensis)
1999 Case Definition

CSTE Position Statement(s)

  • 09-ID-66

Clinical Description

An illness characterized by several distinct forms, including the following:

  • Ulceroglandular: cutaneous ulcer with regional lymphadenopathy
  • Glandular: regional lymphadenopathy with no ulcer
  • Oculoglandular: conjunctivitis with preauricular lymphadenopathy
  • Oropharyngeal: stomatitis or pharyngitis or tonsillitis and cervical lymphadenopathy
  • Intestinal: intestinal pain, vomiting, and diarrhea
  • Pneumonic: primary pleuropulmonary disease
  • Typhoidal: febrile illness without early localizing signs and symptoms

Laboratory Criteria for Diagnosis


  • Elevated serum antibody titer(s) to Francisella tularensis antigen (without documented fourfold or greater change) in a patient with no history of tularemia vaccination, OR
  • Detection of F. tularensis in a clinical specimen by fluorescent assay
  • Isolation of F. tularensis in a clinical specimen, OR
  • Fourfold or greater change in serum antibody titer to F. tularensis antigen


Clinical diagnosis is supported by evidence or history of a tick or deerfly bite, exposure to tissues of a mammalian host of F. tularensis, or exposure to potentially contaminated water.

Case Classification


A clinically compatible case with laboratory results indicative of presumptive infection


A clinically compatible case with confirmatory laboratory results


The 1996 case definition appearing on this page was re-published in the 1999 CSTE position statement 1999-ID-6 and the 2009 CSTE position statement 09-ID-66. Thus, the 1996, 1999, and 2010 versions of the case definition are identical.