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</div><div><span>Tularemia</span></div></div>
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<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
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</a><h1 class="with-also" itemprop="name">Tularemia</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Tularemia is a bacterial infection in wild rodents. The bacteria are passed to humans through contact with tissue from the infected animal. The bacteria can also be passed by <a test="test" href="./002856.htm">ticks</a>, biting flies, and mosquitoes.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>Tularemia is caused by the bacterium <em>Francisella tularensis.</em></p><p>Humans can get the disease through:</p><ul><li>A bite from an infected tick, horsefly, or mosquito</li><li>Breathing in infected dirt or plant material</li><li>Direct contact, through a break in the skin, with an infected animal or its dead body (most often a rabbit, muskrat, beaver, or squirrel)</li><li>Eating infected meat (rare) </li></ul><p>The disorder most commonly occurs in North America and parts of Europe and Asia. In the United States, this disease is found more often in Missouri, South Dakota, Oklahoma, and Arkansas. Although outbreaks can occur in the United States, they are rare.</p><p>Some people may develop <a test="test" href="./000079.htm">pneumonia</a> after breathing in infected dirt or plant material. This infection has been known to occur on Martha's Vineyard (Massachusetts), where bacteria are present in rabbits, raccoons, and skunks.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms develop 3 to 5 days after exposure. The illness usually starts suddenly. It may continue for several weeks after symptoms begin.</p><p>Symptoms include:</p><ul><li>
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Fever, chills, sweating
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</li><li>Eye irritation (called <a test="test" href="./001010.htm">conjunctivitis</a>, if the infection began in the eye)</li><li>
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Headache
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</li><li>
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Joint stiffness, muscle pain
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</li><li>Red spot on the skin, growing to become a sore (ulcer)</li><li><a test="test" href="./003075.htm">Shortness of breath</a></li><li><a test="test" href="./003107.htm">Weight loss</a></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Tests for the condition include:</p><ul><li><a test="test" href="./003744.htm">Blood culture</a> for the bacteria</li><li>Blood test measuring the body's immune response (antibodies) to the infection (<a test="test" href="./003523.htm">serology for tularemia</a>)</li><li><a test="test" href="./003804.htm">Chest x-ray</a></li><li>Polymerase chain reaction (PCR) test of a sample from an ulcer </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>The goal of treatment is to cure the infection with antibiotics.</p><p>The antibiotics streptomycin and tetracycline are commonly used to treat this infection. Another antibiotic, gentamicin, has been tried as an alternative to streptomycin. Gentamicin seems to be very effective, but it has been studied in only a small number of people because this is a rare disease. The antibiotics tetracycline and chloramphenicol can be used alone but are not usually a first choice.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>Tularemia is fatal in about 5% of untreated cases, and in less than 1% of treated cases.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Tularemia may lead to these complications:</p><ul><li>Bone infection (<a test="test" href="./000437.htm">osteomyelitis</a>)</li><li>Infection of the sac around the heart (<a test="test" href="./000182.htm">pericarditis</a>)</li><li>Infection of the membranes covering the brain and spinal cord (<a test="test" href="./000680.htm">meningitis</a>)</li><li>
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Pneumonia
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</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your health care provider if symptoms develop after a rodent bite, tick bite, or exposure to the flesh of a wild animal.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Preventive measures include wearing gloves when skinning or dressing wild animals and staying away from sick or dead animals.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Deerfly fever; Rabbit fever; Pahvant Valley plague; Ohara disease; Yato-byo (Japan); Lemming fever</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1119t.jpg" alt="Deer ticks" title="Deer ticks" class="side-img"/><a href="../imagepages/1119.htm">Deer ticks</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1254t.jpg" alt="Ticks" title="Ticks" class="side-img"/><a href="../imagepages/1254.htm">Ticks</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/2060t.jpg" alt="Tick imbedded in the skin" title="Tick imbedded in the skin" class="side-img"/><a href="../imagepages/2060.htm">Tick imbedded in the skin</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Auwaerter PG, Penn RL. <em>Francisella tularensis</em> (tularemia). In: Bennett JE, Dolin R, Blaser MJ, eds. <em>Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases</em>. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 227.</p><p>Bloch KC, Schaffner W. Tularemia and other <em>Francisella</em> infections. In: Goldman L, Schafer AI, eds. <em>Goldman-Cecil Medicine</em>. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 295.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 2/11/2023</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. </p>
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