INTRODUCTION
Tularemia is a zoonotic infection caused by Francisella tularensis, an aerobic and fastidious gram-negative bacterium. Human infection occurs following contact with infected animals or invertebrate vectors. Synonyms include Francis disease, deer-fly fever, rabbit fever, market men disease, water-rat trappers disease, wild hare disease (yato-byo), and Ohara disease [1]. The clinical manifestations of 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 "Tularemia: Microbiology, epidemiology, and pathogenesis".)
CLINICAL MANIFESTATIONS
Initial nonspecific symptoms — Tularemia usually has an abrupt or rapid onset of nonspecific systemic symptoms, including fever, chills, anorexia, and malaise, which occur approximately three to five days (range 1 to 21 days) following exposure. Classically, the fever may abate after a few days but then quickly return. Other nonspecific symptoms include headache, fatigue, soreness in the chest or muscles, abdominal pain, emesis, or diarrhea. In some patients, these systemic symptoms may have waned by the time of evaluation.
When patients do come to medical attention, they usually have specific clinical manifestations associated with one of the six major clinical forms of tularemia, depending on the portal of entry [2]:
●Ulceroglandular tularemia