Tularemia

What it is

From: Orphanet

A rare bacterial infectious disease caused by Francisella tularensis and characterized by six major clinical presentations: ulceroglandular, glandular, oropharyngeal, oculoglandular, pneumonic, or typhoidal, depending on the route of infection. Early flu-like symptoms are common to all forms and are accompanied/followed by either a skin inoculation ulcer with localized lymphadenopathy; isolated lymphadenopathy; chronic pharyngitis with cervical lymphadenopathy; conjunctivitis with localized lymphadenopathy; lung involvement; severe systemic disease with neurological symptoms.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Arthralgia · Frequent (79-30%)

Joint pain.

Asthenia · Frequent (79-30%)

A state characterized by a feeling of weakness and loss of strength leading to a generalized weakness of the body.

Chills · Frequent (79-30%)

A sudden sensation of feeling cold.

Fever · Frequent (79-30%)

Body temperature elevated above the normal range.

Headache · Frequent (79-30%)

Cephalgia, or pain sensed in various parts of the head, not confined to the area of distribution of any nerve.

Increased circulating immunoglobulin concentration · Frequent (79-30%)

An increased level of gamma globulin (immunoglobulin) in the blood.

Increased total leukocyte count · Frequent (79-30%)

An abnormal increase in the number of leukocytes in the blood.

Myalgia · Frequent (79-30%)

Pain in muscle.

Pneumonia · Frequent (79-30%)

Inflammation of any part of the lung parenchyma.

Tachycardia · Frequent (79-30%)

A rapid heartrate that exceeds the range of the normal resting heartrate for age.

Abnormal pulmonary thoracic imaging finding · Occasional (29-5%)

This term groups terms representing abnormal findings derived from chest X-ray investigation of the lung. In general, lung abnormalities can manifest as opacities (areas of increased density) or as regions with decreased density.

Anemia · Occasional (29-5%)

A reduction in erythrocytes volume or hemoglobin concentration.

Cervical lymphadenopathy · Occasional (29-5%)

Enlarged lymph nodes in the neck.

Cough · Occasional (29-5%)

A sudden, audible expulsion of air from the lungs through a partially closed glottis, preceded by inhalation.

Other findings in the same source

From: Orphanet

Additional reported features include Localized skin lesion (Occasional (29-5%)); Lymphadenopathy (Occasional (29-5%)); Neck pain (Occasional (29-5%)); Oral ulcer (Occasional (29-5%)); Pharyngitis (Occasional (29-5%)); Pleural effusion (Occasional (29-5%)); Respiratory distress (Occasional (29-5%)); Skin rash (Occasional (29-5%)); Thrombocytopenia (Occasional (29-5%)); Pulmonary infiltrates (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

All ages

Inheritance in the source

From: Orphanet

Not applicable

Frequency and the population described

From: Orphanet

Annual incidence: <1 / 1 000 000; United Kingdom; Class only. Annual incidence: <1 / 1 000 000; Netherlands; Class only. Annual incidence: 1-9 / 100 000; Sweden; Value and class. Annual incidence: 1-9 / 100 000; Czech Republic; Value and class.

Which doctor should you see?

The suggested department for discussing Tularemia is Infectious Diseases, with a general physician / infectious disease specialist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which exposure or organism is suspected, and what evidence would confirm it?
• Are precautions, vaccination or advice for close contacts relevant to this infection?
• What should happen if symptoms worsen or do not improve as expected?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Tularemia. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.