Chapter 12 : Tularemia

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Tularemia, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816490/9781555812386_Chap12-1.gif /docserver/preview/fulltext/10.1128/9781555816490/9781555812386_Chap12-2.gif


Tularemia is a disease caused by infection with the bacterium . The disease is manifested by a broad range of signs and symptoms that include one or more of the following: an ulcer at the initial site of infection, regional lymphadenopathy, fever, chills, headache, malaise, sore throat, cough, abdominal pain, vomiting, diarrhea, and, in severe forms, dyspnea and septic shock. Primary or secondary pneumonia may occur following inhalation of or after dissemination to the lung from other infected sites, respectively. This chapter first discusses the etiologic agent and biology of . Then, it talks about the role of ticks in transmission of . Tularemia is notable among infectious diseases for its high infectivity and many routes of transmission, yet surprisingly it is not contagious between people. Humans can acquire tularemia by handling, skinning, eating, or being scratched or bitten by infected vertebrates; handling or being bitten by infected arthropods; drinking contaminated water; making skin contact with contaminated mud or water; or inhaling infective aerosols. The clinical manifestations of tularemia depend on the route and mechanism of inoculation, the virulence of the infecting bacterial strain, and the host response of the infected person. Next, the chapter describes six primary clinical syndromes of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic, and typhoidal. The chapter ends with a discussion on diagnosis, treatment, and prevention of tularemia.

Citation: Hayes E. 2005. Tularemia, p 207-217. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch12

Key Concept Ranking

Outer Membrane Proteins
Enzyme-Linked Immunosorbent Assay
Infectious Diseases
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Abd, H.,, T. Johansson,, I. Golovliov,, G. Sandstrom,, and M. Forsman. 2003. Survival and growth of Francisella tularensis in Acanthamoeba castellanii. Appl. Environ. Microbiol. 69:600606.
2. Acha, P. N.,, and B. Szyfres. 2003. Zoonoses and Communicable Diseases Common to Man and Animals, 3rd ed., vol. 1. Bacterioses and Mycoses. Pan American Health Organization, Washington, D.C.
3. Anda, P.,, J. Segura Del Pozo,, J. M. Diaz Garcia,, R. Escudero,, F. J. Garcia Pena,, M. C. Lopez Velasco,, R. E. Sellek,, M. R. Jimenez Chillaron,, L. P. Sanchez Serrano,, and J. F. Martinez Navarro. 2001. Waterborne outbreak of tularemia associated with crayfish fishing. Emerg. Infect. Dis. 7:575582.
4. Berdal, B. P.,, R. Mehl,, N. K. Meidell,, A. M. Lorentzen-Styr,, and O. Scheel. 1996. Field investigations of tularemia in Norway. FEMS Immunol. Med. Microbiol. 13:191195.
5. Burgdorfer, W.,, and C. Owen. 1956. Experimental studies on argasid ticks as possible vectors of tularemia. J. Infect. Dis. 98: 6774.
6. Burke, D. S. 1977. Immunization against tularemia: analysis of the effectiveness of live Francisella tularensis vaccine in prevention of laboratory-acquired tularemia. J. Infect. Dis. 135:5560.
7. Byfield, G. U.,, L. Breslow,, R. R. Cross, Jr.,, and N. J. Hershey. 1945. Tick borne tularemia. Report of fifteen cases. JAMA 127:191196.
8. Calhoun, E. L. 1954. Natural occurrence of tularemia in the lone star tick, Ambylomma americanum (Linn.), and in dogs in Arkansas. Am. J. Trop. Med. Hyg. 3:360366.
9.Centers for Disease Control and Prevention. 2002. Tularemia—United States, 1990-2000. Morb. Mortal. Wkly. Rep. 51:181184.
10. Christenson, B. 1984. An outbreak of tularemia in the northern part of central Sweden. Scand. J. Infect. Dis. 16:285290.
11. Chu, M. C.,, and R. S. Weyant,. 2003. Francisella and Brucella, p. 789808. In K. V. Forrest,, J. H. Jorgensen,, and P. R. Murray (ed.), Manual of Clinical Microbiology, 8th ed. American Society for Microbiology, Washington, D.C.
12. Cross, J. T.,, and R. F. Jacobs. 1993. Tularemia: treatment failures with outpatient use of ceftriaxone. Clin. Infect. Dis. 17: 976980.
13. Cross, J. T.,, and R. L. Penn,. 2000. Francisella tularensis (Tularemia), p. 23932402. In G. L. Mandell,, J. E. Bennett,, and R. Dolan (ed.), Mandell’s Principles and Practice of Infectious Diseases, 5th ed. Churchill Livingstone, Inc., New York, N.Y.
14. Cross, J. T., Jr.,, G. E. Schutze,, and R. F. Jacobs. 1995. Treatment of tularemia with gentamicin in pediatric patients. Pediatr. Infect. Dis. J. 14:151152.
15. Dahlstrand, S.,, O. Ringertz,, and B. Zetterberg. 1971. Airborne tularemia in Sweden. Scand. J. Infect. Dis. 3:716.
16. Dennis, D. T., 2004. Tularemia, p. 14461451. In S. L. Gorbach,, J. G. Bartlett,, and N. R. Blacklow (ed.), Infectious Disease, 3rd ed. Lippincott Williams and Wilkins, New York, N.Y.
17. Dennis, D. T.,, T. V. Inglesby,, D. A. Henderson,, J. G. Bartlett,, M. S. Ascher,, E. Eitzen,, A. D. Fine,, A. M. Friedlander,, J. Hauer,, M. Layton,, S. R. Lillibridge,, J. E. McDade,, M. T. Osterholm,, T. O’Toole,, G. Parker,, T. M. Perl,, P. K. Russell,, and K. Tonat. 2001. Tularemia as a biological weapon: medical and public health management. JAMA 285:27632773.
18. Eliasson, H.,, J. Linback,, J. Nuorti,, M. Arneborn,, J. Giesecke,, and A. Tegnell. 2002. The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden. Emerg. Infect. Dis. 8:956960.
19. Ellis, J.,, P. C. F. Oyston,, M. Green,, and R. W. Titball. 2002. Tularemia. Clin. Microbiol. Rev. 15:631646.
20. Enderlin, G.,, L. Morales,, R. F. Jacobs,, and J. T. Cross. 1994. Streptomycin and alternative agents for the treatment of tularemia: review of the literature. Clin. Infect. Dis. 19:4247.
21. Ericsson, M.,, A. Tarnvik,, K. Kuoppa,, G. Sandstrom,, and A. Sjostedt. 1994. Increased synthesis of DnaK, GroEL, and GroES homologs by Francisella tularensis LVS in response to heat and hydrogen peroxide. Infect. Immun. 62:178183.
22. Evans, M. E.,, D. W. Gregory,, W. Schaffner,, and Z. A. McGee. 1985. Tularemia: a 30-year experience with 88 cases. Medicine 64:251269.
23. Feldman, K. A.,, R. E. Enscore,, S. L. Lathrop,, B. T. Matyas,, M. McGuill,, M. E. Schriefer,, D. Stiles-Enos,, D. T. Dennis,, L. R. Petersen,, and E. B. Hayes. 2001. An outbreak of primary pneumonic tularemia on Martha’s Vineyard. N. Engl. J. Med. 345:16011606.
24. Feldman, K. A.,, D. Stiles-Enos,, K. Julian,, B. T. Matyas,, S. R. Telford III,, M. C. Chu,, L. R. Petersen,, and E. B. Hayes. 2003. Tularemia on Martha’s Vineyard: seroprevalence and occupational risk. Emerg. Infect. Dis. 9:350354.
25. Francis, E. 1921. The occurrence of tularemia in nature as a disease of man. Public Health Rep. 36:17311751.
26. Francis, E. 1925. Tularemia. JAMA 84:12431250.
27. Gallivan, M. V.,, W. A. Davis II,, V. F. Garagusi,, A. L. Paris,, and E. E. Lack. 1980. Fatal cat-transmitted tularemia: demonstration of the organism in tissue. South. Med. J. 73:240242.
28. Golovliov, I.,, M. Ericsson,, G. Sandstrom,, A. Tarnvik,, and A. Sjostedt. 1997. Identification of proteins of Francisella tularensis induced during growth in macrophages and cloning of the gene encoding a prominently induced 23-kilodalton protein. Infect. Immun. 65:21832189.
29. Green, R. G. 1931. The occurrence of Bacterium tularense in the Eastern wood tick, Dermacentor variabilis. Am. J. Hyg. 14:600613.
30. Grunow, R.,, W. Splettstoesser,, S. McDonald,, C. Otterbein,, T. O’Brien,, C. Morgan,, J. Aldrich,, E. Hofer,, E. J. Finke,, and H. Meyer. 2000. Detection of Francisella tularensis in biological specimens using a capture enzyme-linked immunosorbent assay, an immunochromatographic handheld assay, and a PCR. Clin. Diagn. Lab. Immunol. 7:8690.
31. Guerrant, R. L.,, M. K. Humphries, Jr.,, J. E. Butler,, and R. S. Jackson. 1976. Tickborne oculoglandular tularemia: case report and review of seasonal and vectorial associations in 106 cases. Arch. Intern. Med. 136:811813.
32. Gurycova, D.,, E. Kocianova,, V. Vyrostekova,, and J. Rehacek. 1995. Prevalence of ticks infected with Francisella tularensis in natural foci of tularemia in western Slovakia. Eur. J. Epidemiol. 11:469474.
33. Gurycova, D.,, V. Vyrostekova,, G. Khanakah,, E. Kocianova,, and G. Stanek. 2001. Importance of surveillance of tularemia natural foci in the known endemic area of central Europe, 1991-1997. Wien. Klin. Wochenschr. 113:433438.
34. Hansen, E. C.,, and R. S. Green. 1929. Tularemia in Minnesota. JAMA 92:19201923.
35. Hillman, C. C.,, and M. T. Morgan. 1937. Tularemia: report of a fulminant epidemic transmitted by the deerfly. JAMA 108: 538540.
36. Hopla, C. E. 1953. Experimental studies on tick transmission of tularemia organisms. Am. J. Hyg. 58:101118.
37. Hopla, C. E. 1960. The transmission of tularemia organisms by ticks in the southern states. South. Med. J. 53:9297.
38. Hopla, C. E.,, and A. K. Hopla,. 1994. Tularemia, p. 113126. In G. W. Beran (ed.), CRC Handbook of Zoonoses, Section A, 2nd ed. CRC Press, Boca Raton, Fla.
39. Hornick, R. B., 1998. Tularemia, p. 823837. In A. S. Evans, and P. S. Brachman (ed.), Bacterial Infections of Humans: Epidemiology and Control, 3rd ed. Plenum Medical Book Company, New York, N.Y.
40. Ikaheimo, I.,, H. Syrjala,, J. Karhukorpi,, R. Schildt,, and M. Koskela. 2000. In vitro antibiotic susceptibility of Francisella tularensis isolated from humans and animals. J. Antimicrob. Chemother. 46:287290.
41. Jacobs, R. F.,, Y. M. Condrey,, and T. Yamaguchi. 1985. Tularemia in adults and children: a changing presentation. Pediatrics 76:818822.
42. Jellison, W. L. 1974. Tularemia in North America, 1930-1974. University of Montana, Missoula, Mont.
43. Johansson, A.,, L. Berglund,, L. Gothefors,, A. Sjostedt,, and A. Tarnvik. 2000. Ciprofloxacin for treatment of tularemia in children. Pediatr. Infect. Dis. J. 19:449453.
44. Johansson, A. L.,, L. Berglund,, A. Sjostedt,, and A. Tarnvik. 2001. Ciprofloxacin for treatment of tularemia. Clin. Infect. Dis. 33:267268.
45. Karpov, S. P.,, and N. I. Antonoff. 1936. The spread of tularemia through water, as a new factor in its epidemiology. J. Bacteriol. 32:243258.
46. Khazova, T. G.,, and V. K. Iastrebov. 2001. Combined focus of tick-borne encephalitis, tick-borne rickettsiosis and tularemia in the habitat of Haemaphysalis concinna in south-central Siberia. Zh. Mikrobiol. Epidemiol. Immunobiol. 2001:7880. (In Russian.)
47. Klock, L. E.,, P. F. Olsen,, and T. Fukushima. 1973. Tularemia epidemic associated with the deerfly. JAMA 226:149152.
48. Kohls, G. M.,, and B. Locker. 1954. Isolation of Pasteurella tularensis from the tick Ixodes ricinus in Norway. Nord. Vet. Med. 6:883884.
49. Lopez, C. E.,, A. N. Kornblatt,, R. K. Sikes,, and O. E. Hanes. 1982. Tularemia: review of eight cases of tick-borne infection and the epidemiology of the disease in Georgia. South. Med. J. 75:405407.
50. Lovell, V. M.,, C. T. Cho,, N. J. Lindsey,, and P. L. Nelson. 1986. Francisella tularensis meningitis: a rare clinical entity. J. Infect. Dis. 154:916918.
51. Markowitz, L. E.,, N. A. Hynes,, P. de la Cruz,, E. Campos,, J. M. Barbaree,, B. D. Plikaytis,, D. Mosier,, and A. F. Kaufmann. 1985. Tick-borne tularemia. An outbreak of lymphadenopathy in children. JAMA 254:29222925.
52. Maurin, M.,, N. F. Mersali,, and D. Raoult. 2000. Bactericidal activities of antibiotics against intracellular Francisella tularensis. Antimicrob. Agents Chemother. 44:34283431.
53. Miller, R. P.,, and J. H. Bates. 1969. Pleuropulmonary tularemia. A review of 29 patients. Am. Rev. Respir. Dis. 99:3141.
54. Ohara, Y.,, T. Sato,, and M. Homma. 1998. Arthropod-borne tularemia in Japan: clinical analysis of 1,374 cases observed between 1924 and 1996. J. Med. Entomol. 35:471473.
55. Parker, R. R.,, C. S. Brooks,, and H. Marsh. 1929. The occurrence of Bacterium tularense in the wood tick (Dermacentor occidentalis) in California. Public Health Rep. 44:12991300.
56. Parker, R. R.,, R. R. Spencer,, and E. Francis. 1924. Tularemia XI: tularemia infection in ticks of the species Dermacentor andersonii stiles in the Bitter Root Valley, Montana. Public Health Rep. 39:10571073.
57. Philip, C. B.,, and W. L. Jellison. 1934. The American dog tick, Dermacentor variabilis as a host of Bacterium tularense. Public Health Rep. 49.
58. Pollitzer, R. 1967. History and incidence of tularemia in the Soviet Union. Institute of Contemporary Russian Studies, Fordham University, Bronx, N.Y.
59. Reintjes, R.,, I. Dedushaj,, A. Gjini,, T. R. Jorgensen,, B. Cotter,, A. Lieftucht,, F. D’Ancona,, D. T. Dennis,, M. A. Kosoy,, G. Mulliqi-Osmani,, R. Grunow,, A. Kalaveshi,, L. Gashi,, and I. Humoli. 2002. Tularemia outbreak investigation in Kosovo: case control and environmental studies. Emerg. Infect. Dis. 8: 6973.
60. Saliba, G. S.,, F. C. Harmston,, B. E. Diamond,, C. L. Zymet,, M. I. Goldenberg,, and T. D. Chin. 1966. An outbreak of human tularemia associated with the American dog tick, Dermacentor variabilis. Am. J. Trop. Med. Hyg. 15:531538.
61. Saslaw, S.,, H. T. Eigelsbach,, J. A. Prior,, H. E. Wilson,, and S. Carhart. 1961. Tularemia vaccine study. II. Respiratory challenge. Arch. Intern. Med. 107:702714.
62. Saslaw, S.,, H. T. Eigelsbach,, H. E. Wilson,, J. A. Prior,, and S. Carhart. 1961. Tularemia vaccine study. I. Intracutaneous challenge. Arch. Intern. Med. 107:689701.
63. Sawyer, W. D.,, H. G. Dangerfield,, A. L. Hogge,, and D. Crozier. 1966. Antibiotic prophylaxis and therapy of airborne tularemia. Bacteriol. Rev. 30:542550.
64. Scheel, O.,, T. Hoel,, T. Sandvik,, and B. P. Berdal. 1993. Susceptibility pattern of Scandinavian Francisella tularensis isolates with regard to oral and parenteral antimicrobial agents. APMIS 101:3336.
65. Schmid, G. P.,, A. N. Kornblatt,, C. A. Connors,, C. Patton,, J. Carney,, J. Hobbs,, and A. F. Kaufmann. 1983. Clinically mild tularemia associated with tick-borne Francisella tularensis. J. Infect. Dis. 148:6367.
66. Syrjala, H.,, J. Karvonen,, and A. Salminen. 1984. Skin manifestations of tularemia: a study of 88 cases in northern Finland during 16 years (1967-1983). Acta Derm. Venereol. (Stockholm) 64:513516.
67. Tarnvik, A. 1989. Nature of protective immunity to Francisella tularensis. Rev. Infect. Dis. 11:440451.
68. Taylor, J. P.,, G. R. Istre,, T. C. McChesney,, F. T. Satalowich,, R. L. Parker,, and L. M. McFarland. 1991. Epidemiologic characteristics of human tularemia in the southwest-central states, 1981-1987. Am. J. Epidemiol. 133:10321038.
69. Teutsch, S. M.,, W. J. Martone,, E. W. Brink,, M. E. Potter,, G. Eliot,, R. Hoxsie,, R. B. Craven,, and A. F. Kaufmann. 1979. Pneumonic tularemia on Martha’s Vineyard. N. Engl. J. Med. 301:826828.
70. Treml, F.,, Z. Hubalek,, J. Halouzka,, Z. Juricova,, M. Hunady,, and V. Janik. 2001. Analysis of the incidence of tularemia in the Breclav district 1994-1999. Epidemiol. Mikrobiol. Imunol. 50:49. (In Czech.)
71. Uhari, M.,, H. Syrjala,, and A. Salminen. 1990. Tularemia in children caused by Francisella tularensis biovar palaearctica. Pediatr. Infect. Dis. J. 9:8083.
72. Warring, W. B.,, and J. S. Ruffin. 1946. A tick-borne epidemic of tularemia. N. Engl. J. Med. 234:137140.
73. Weinberg, A. N. 2004. Commentary: Wherry W. B., Lamb B. H. Infection of man with Bacterium tularense. J. Infect. Dis. 1914; 15:33140. J. Infect. Dis. 189:13171331.
74. Young, L. S.,, D. S. Bickness,, B. G. Archer,, J. M. Clinton,, L. J. Leavens,, J. C. Feeley,, and P. S. Brachman. 1969. Tularemia epidemic: Vermont, 1968. Forty-seven cases linked to contact with muskrats. N. Engl. J. Med. 280:12531260.

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error