Tularemia is a highly infectious disease you get from the bacterium F. tularensis. You can get it from bug bites, infected animals, contaminated water or food, and particles of bacteria in the air. Tularemia can affect your skin, eyes, throat, lungs and intestines. Tularemia should be treated as soon as possible with antibiotics.
Tularemia is an illness you get from the bacterium Francisella tularensis (F. tularensis). It causes your lymph nodes to painfully swell and other symptoms in your lungs, eyes, throat and intestines, depending on where the bacteria infects you.
Tularemia is a zoonotic disease, which means it spreads between animals and humans. Commonly called “rabbit fever” or “deer fly fever,” people get tularemia from exposure to deer flies and ticks that have F. tularensis infections. You can also get it from contact with infected animals (generally rabbits, hares and rodents) or food and water sources contaminated with the bacteria.
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Tularemia can cause your lymph nodes to swell severely, which looks like large bumps on your body. Sometimes it causes broken skin (ulceration) at the site where F. tularensis bacteria entered your body.
Tularemia can affect anyone, but your work, hobbies or other aspects of your life can put you in closer contact with animals and bugs infected with F. tularensis. You could be at higher risk for tularemia if you:
There are fewer than 300 cases per year reported in the U.S., coming from all states except Hawaii, but it’s most common in the south-central United States, the Great Plains region, and parts of Massachusetts.
Tularemia can affect your lymph nodes, skin, eyes, throat, intestines (gut) or lungs. In severe cases, it can cause inflammation in any organ, including your brain and heart.
F. tularensis bacteria get into your body and are “eaten” (engulfed) by cells of your immune system. Typically these cells would destroy the bacteria, but instead, the bacteria multiply inside of them. The bacteria destroy the immune cell and flood out into your body to infect other cells.
The destruction of cells and your immune system’s response to the bacteria causes symptoms in the part of your body that’s infected.
Tularemia has several forms, depending on how you got infected with F. tularensis and where your symptoms are. Types of tularemia include:
Ulceroglandular tularemia is the most common form of tularemia. You usually get it from being bitten by a tick or an infected animal. It affects your skin and lymph nodes.
Glandular tularemia is similar to ulceroglandular tularemia, but it only affects your lymph nodes. You get glandular tularemia from a tick bite or directly from an infected animal.
You get oculoglandular tularemia if you get contaminated water or body fluids in your eye. It causes symptoms in and around your infected eye. Oculoglandular tularemia usually doesn’t affect both eyes.
You get oropharyngeal tularemia from eating contaminated food, drinking contaminated water or touching your hands to your mouth without washing them. It causes a sore throat and sometimes digestive (gastrointestinal) symptoms.
Pneumonic tularemia is the most serious form of tularemia. It causes symptoms similar to pneumonia. You can get pneumonic tularemia two ways:
Typhoidal tularemia causes a high fever and affects many parts of your body. You can get typhoidal tularemia the same way as other forms of tularemia.
While tularemia has some symptoms that are similar to Lyme disease, they affect your body differently. Tularemia can affect many parts of your body and cause life-threatening illness. Lyme is usually not life-threatening, though it can cause long-lasting symptoms that are hard to treat.
Symptoms of tularemia depend on what form you have. Most forms cause a fever, various types of rash and additional symptoms specific to where the infection is in your body.
Some people may also have:
The incubation period for tularemia, or time between exposure and the start of symptoms, is three to five days. Some people can go without symptoms for up to two weeks.
The bacterium F. tularensis causes tularemia. It lives in animals (when animals carry diseases like this, they’re known as “reservoirs”) — usually rabbits, hares, rodents and cats — and can ticks and other biting insects can also carry it.
There are two types of F. tularensis, type A and type B. Type A causes more serious illness and is found in the U.S. Type B causes mild symptoms and is found in North America and most other parts of the world.
Tularemia spreads (is transmitted) in many different ways. You can get tularemia from:
No, tularemia isn’t contagious — there’s no evidence that it can spread directly from person to person. However, it’s highly infectious, which means exposure to even small amounts of the bacteria can be enough for you to get sick .
While cooking to a safe temperature kills bacteria, you shouldn’t eat an animal that you know had tularemia.
To diagnose tularemia, a healthcare provider will examine you, ask you about your symptoms and test your blood or other body fluids. Depending on your symptoms, they might look at your lymph nodes, your throat, your eyes and any ulcers, bumps or rashes you have on your skin.
Tests and imaging your provider might do to diagnose tularemia include:
Treatment of tularemia involves broad-spectrum antibiotics, either given to you by a healthcare provider with a needle (injection) or taken by mouth (pill). You may need other treatments if you have serious complications.
It’s important to treat tularemia as soon as possible. Your provider may give you antibiotics before your test results are back to keep you from getting seriously ill.
Yes, tularemia is curable in humans. Antibiotics can kill the bacteria that causes tularemia.
Antibiotics used to treat tularemia include:
It’s important to take all of your prescribed medication until it’s gone unless otherwise directed by your provider. If you stop taking antibiotics too early, some bacteria could remain in your body, causing you to become sick again.
In addition to prescribed antibiotics, you may be able to manage some symptoms of tularemia at home. Ask your healthcare provider if there are over-the-counter (OTC) medications or other therapies that are safe for treating your symptoms.
You can reduce your risk of tularemia by protecting yourself and your pets from bug bites, safely handling animals and cooking meat to safe temperatures.
Most people with tularemia make a full recovery. You can expect to be on antibiotics for 10 to 21 days.
Depending on your symptoms, your healthcare provider may monitor you closely for the first couple of days of treatment. If your symptoms began a while before starting antibiotics, you could have serious complications.
Some people’s symptoms come back after they feel better (relapse). If this happens to you, you may have to take another course of antibiotics.
Treatment for tularemia lasts for two to three weeks, but it could take longer than that to feel completely better. Sometimes rashes from tularemia leave permanent scars on your skin.
Tularemia doesn’t spread between people, so you should be able to go back to work or school whenever you feel able.
With prompt treatment, the outlook for tularemia is good. Less than 1% of cases of tularemia are fatal when treated quickly with antibiotics.
Complications of tularemia usually happen in connection with pneumonic or typhoidal tularemia, and include:
Some people might recover from tularemia without antibiotics, but the risk for severe complications, including organ damage, is high. Up to 30% of untreated cases of type A tularemia are fatal.
See a healthcare provider if you:
Go to the nearest ER if you have any symptoms of serious illness:
Since it’s highly infectious, there are concerns that F. tularensis, the bacterium that causes tularemia, could be used as a biological weapon. However, there are no records or confirmed reports of biological weapon-related tularemia outbreaks.
A note from Cleveland Clinic
Tularemia is a rare but serious illness. If you think you were exposed to or have symptoms of tularemia, see a healthcare provider right away. With quick treatment, you can make a full recovery.
Last reviewed by a Cleveland Clinic medical professional on 08/25/2022.
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