Tularemia – zoonotic infection caused by Francisella tularensis, a highly infectious Gram-negative bacillus.
Occurs in Northern Hemisphere (esp. USA, Scandinavia, Eastern Europe, Russia).
Extremely low infectious dose (10–50 organisms) → classified as a potential bioterrorism agent.

🦠 Aetiology & Transmission

Vectors: Tick bites (e.g. Dermacentor, Amblyomma), mosquitoes.
Reservoirs: Wild rabbits, hares, rodents, domestic cats/dogs.
Transmission routes: Tick/insect bite, contact with infected animals, ingestion of contaminated water, inhalation of aerosols, mucous membrane exposure (e.g. conjunctiva).
UK relevance: Rare, but imported cases possible; notifiable disease.

🩺 Clinical Presentations

Ulceroglandular (most common): Painful ulcer at inoculation site + regional lymphadenopathy.
Glandular: Lymphadenopathy without skin ulcer.
Oculoglandular: Conjunctivitis + preauricular/cervical nodes (from eye contamination).
Pneumonic: Inhalation → pneumonia, cough, chest pain; severe, high mortality if untreated.
Typhoidal: Septicaemic form with high fever, systemic toxicity, multi-organ involvement, no lymphadenopathy. 🚨 Life-threatening.

📊 Quick Comparison of Forms

Form	Key Features
Ulceroglandular	Skin ulcer + lymphadenopathy (most common)
Glandular	Lymphadenopathy only, no ulcer
Oculoglandular	Conjunctivitis + painful regional nodes
Pneumonic	Pneumonia, chest pain, severe systemic illness
Typhoidal	Sepsis picture, multi-organ, no lymphadenopathy

🧪 Investigations

Serology: Tube agglutination test (≥1:160 or four-fold rise in titre).
PCR: Useful in early/pulmonary cases.
Culture: Gold standard but biohazard → only in specialist labs.
Imaging: CXR in pneumonic cases: lobar pneumonia or pleural effusion.

💊 Management

First-line (severe): IV Gentamicin or Streptomycin × 7–10 days.
Milder disease: Doxycycline or Ciprofloxacin PO × 14 days.
⚠️ Short courses risk relapse.
Supportive care: Hydration, analgesia, antipyretics. Hospitalisation for severe forms.
Infection control: Standard precautions; human-to-human spread is rare.

🛡️ Prevention

Protective clothing, insect repellents in endemic areas.
Avoid handling sick/dead wild animals without PPE.
Public health: Notify UKHSA/PHE if suspected; raise awareness in endemic regions.

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Tularaemia (Francisella tularensis)

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