Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1B94.Z

  • Chapin & Mc Coy 1912.
  • Wherry & Lamb 1914.

Rabbit fever, rabbit plague, rodent disease, lemming disease, lemming fever, deer fly fever, Ohara's disease, Francisella tularensis infection, deer fly fever.

Notifiable, plague-like rodent disease caused by the gram-negative, coccoid, rod Francisella tularensis, mucoglandular tularaemia, ulcero-glandular tularaemia, oculoglandular tularaemia, typhoid tularaemia, allergic tularaemia.

  • Rare in Europe.
  • Mostly occurring in people from the rural population or hunters.
  • In particular, <10 or >60-year-olds are affected.

  • Pathogen
    • Francisella tularensis.
    • Francisella tularensis enters the human organism through small skin lesions, mosquitoes and ticks or the GI tract.
  • Transmission: skin or mucosal contact with infected animals, ingestion or transmission by mosquitoes and ticks or through contaminated water.
  • Pathogen reservoirs: hares, beavers, ticks.
  • Incubation period: 2-14 days.

  • Localisation
    • In particular hands.
  • In addition to cephalgias, myalgias, arthralgias and febrile temperatures, symptoms occur which are assigned to 6 different forms of manifestation.
  • Ulcero-glandular tularemia
    • Most common.
    • The causative agent enters via skin defects.
    • The primary manifestation (this may be absent, but several may occur simultaneously) is in the form of a small nodular, blue-red infiltrate or ulcerated pustule.
    • Locoregional lymph node adenopathy, which often persists for 2-3 weeks and then melts and fistulates).
  • Mucoglandular tularemia
    • Entry of the causative agent via the oral mucosa, where aphthous formation occurs.
    • Locoregional lymph node adenopathy
    • Oculoglandular tularemia
      • occurrence of conjunctivitis and/or eyelid oedema.
      • Locoregional lymph node adenopathy, usually preauricular or submandibular.
    • Typhoid tularemia
      • Reduced general condition.
      • Diarrhoea, abdominal pain.
      • With concomitant pneumonia also dysnoea.
      • Sepsis represents a complication.
    • Allergic tularemia
      • Polymorphous, maculopapular exanthema or nodular erythema.

  • Anamnesis (contact with animals, age, place of residence).
  • Clinical.
  • Detection of pathogens (bact. smear).
  • The serum agglutination test is positive from about the 2nd week of illness. A skin test with Francisella tularensis antigen is positive as early as the 1st week of illness.

  • Mediastinitis
  • Pulmonary abscess
  • Meningitis

  1. Carvalho CL, Lopes de Carvalho I, Ze-Ze L, Nuncio MS , Duarte EL. Tularaemia: a challenging zoonosis. Comp Immunol Microbiol Infect Dis 2014;37:85-96.
  2. Boisset S, Caspar Y, Sutera V , Maurin M. New therapeutic approaches for treatment of tularaemia: a review. Front Cell Infect Microbiol 2014;4:40.
  3. Ulu-Kilic A , Doganay M. An overview: tularemia and travel medicine. Travel Med Infect Dis 2014;12:609-16.
  4. Hamblin KA, Wong JP, Blanchard JD , Atkins HS. The potential of liposome-encapsulated ciprofloxacin as a tularemia therapy. Front Cell Infect Microbiol 2014;4:79.
  5. Snowden J , Stovall S. Tularemia: retrospective review of 10 years' experience in Arkansas. Clin Pediatr (Phila) 2011;50:64-8.
  6. Penn, R. (2016). Clinical manifestations, diagnosis, and treatment of tularemia. Uptodate.com. Retrieved 24 May 2016, from http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-tularemia?source=search_result&search=tularemia&selectedTitle=1%7E62