Health Information




Deerfly fever; Rabbit fever; Pahvant Valley plague; Ohara disease; Yato-byo (Japan); Lemming fever

Tularemia is an infection common in wild rodents. It is passed to humans through contact with tissue from the infected animal. It can also be passed by ticks, biting flies, and mosquitoes.

I Would Like to Learn About:

  • Causes

    Tularemia is caused by the bacterium Francisella tularensis.

    Humans can get the disease through:

    • A bite from an infected tick, horsefly, or mosquito
    • Breathing in infected dirt or plant material
    • Direct contact, through a break in the skin, with an infected animal or its dead body (most often a rabbit, muskrat, beaver, or squirrel)
    • Eating infected meat (rare)

    The disorder most commonly occurs in North America and parts of Europe and Asia. In the US, this disease is found more often in Missouri, South Dakota, Oklahoma and Arkansas. Although outbreaks can occur in the United States, they are rare.

    Some people may develop pneumonia after breathing in infected dirt or plant material. This is known to occur on Martha's Vineyard, where bacteria are present in rabbits, raccoons, and skunks.

  • Symptoms

    Symptoms develop 3 to 5 days after exposure. The illness usually starts suddenly. It may continue for several weeks after symptoms begin.

    Symptoms include:

    • Chills
    • Eye irritation (conjunctivitis -- if the infection began in the eye)
    • Fever
    • Headache
    • Joint stiffness
    • Muscle pains
    • Red spot on the skin, growing to become a sore (ulcer)
    • Shortness of breath
    • Sweating
    • Weight loss
  • Exams and Tests

    Tests for the condition include:

    • Blood culture for tularemia bacteria
    • Blood test measuring the body's immune response to the infection (serology for tularemia)
    • Chest x-ray
    • Polymerase chain reaction (PCR) test of a sample from an ulcer

    This disease may also affect the results of febrile agglutinins and some tests for infectious mononucleosis.

  • Treatment

    The goal of treatment is to cure the infection with antibiotics.

    Streptomycin and tetracycline are commonly used to treat this infection. Once daily gentamicin treatment has been tried with as an alternative to streptomycin. This medicine appears to be very effective but it has been studied in only a few cases because this is a rare disease. Tetracycline and chloramphenicol can be used alone but not used as a first choice.

    Note: Oral tetracycline is usually not prescribed for children until after all their permanent teeth have come in. It can permanently discolor teeth that are still forming.

  • Outlook (Prognosis)

    Tularemia is fatal in about 5% of untreated cases, and in less than 1% of treated cases.

  • Possible Complications

    • Bone infection (osteomyelitis)
    • Infection of the sac around the heart (pericarditis)
    • Meningitis
    • Pneumonia
  • When to Contact a Medical Professional

    Call your health care provider if symptoms develop after a rodent bite, tick bite, or exposure to the flesh of a wild animal.

  • Prevention

    Preventative measures include skinning or dressing wild animals with gloves and avoiding sick or dead animals.

Related Information

  Tick biteEndemicAtypical pneumonia...Insect bites and s...MeningitisPneumonia - adults...PericarditisOsteomyelitis     Lyme disease and r...Pneumonia


Penn RL. Francisella tularensis (Tularemia). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 7th ed. Philadelphia, PA: Saunders Elsevier; 2009:chap 227.

Schaffner W. Tularemia and other Francisella infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 319.


Review Date: 1/29/2013  

Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.


A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.