Tularemia is an infection common in wild rodents. It is caused by the organism Francisella tularensis. Tularemia is transmitted to humans by contact with infected animal tissues or by ticks, biting flies, and mosquitoes.

Humans can contract tularemia in the following ways:

• Direct contact, through a break in the skin, with an infected animal or its carcass
• The bite of an infected tick, horsefly, or mosquito
• Eating infected meat (rare)

Endemic areas (areas where the disorder occurs most commonly) include North America and parts of Europe and Asia. The illness may continue for several weeks after symptoms begin.

Some people may develop an atypical pneumonia after infection. Risk factors include recent exposure to rabbits or a recent tick bite. The disease is very rare in the United States.

Francisella tularensis is considered a potential bioterrorism agent. An aerosol release would be a possible method of infection, and would result in pneumonia cases, beginning 1 - 10 days after exposure.

• Chills
• Enlarged lymph nodes of the groin or armpits
• Fever
• Headache
• Joint stiffness
• Muscle pains
• Possible conjunctivitis
• Red spot on the skin, enlarging to an ulcer
• Shortness of breath
• Sweating
• Weight loss

• Serology for tularemia
• PCR (polymerase chain reaction) test of a sample from an ulcer
• Blood culture for tularemia
• Chest x-ray

This disease may also alter the results of febrile/cold agglutinins.