Tularemia

土拉菌病

Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026

Tularemia, also called rabbit fever, is a bacterial zoonosis caused by Francisella tularensis that has been re-emerging across the Northern Hemisphere, especially in Europe ^[1]. The pathogen's low infectious dose and ease of airborne spread have led to its classification as a category A bioterrorism agent ^[1]^[2]. Untreated disease can reach fatality rates as high as 60%, with pneumonic and typhoidal forms showing the worst outcomes ^[1].

Read the full clinical and epidemiological profile 6

Definition

Tularemia, also known as rabbit fever, is a bacterial zoonotic disease caused by Francisella tularensis; it is transmitted via arthropod-borne, air-borne, food- and water-borne routes and is re-emerging in the Northern Hemisphere, particularly in Europe ^[1]. It is also classified as a gram-negative bacterial infection and is recognized as a category A bioterrorism agent due to the ease of airborne transmission ^[1]^[3].

Clinical features

Tularemia presents with six typical clinical pictures resulting from multiple routes of infection: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic forms, along with several uncommon presentations that can potentially affect any body site ^[1]. In pregnancy, the oropharyngeal and ulceroglandular forms were the most common presenting manifestations, with complications including lymph node aspiration, lymph node excision, maternal bleeding, spontaneous abortion, intrauterine fetal demise, and preterm birth ^[3]. As an atypical pneumonia pathogen, F. tularensis may cause extrapulmonary manifestations as part of a systemic infectious disease with a pulmonary component .

Epidemiology

The disease has been re-emerging in the Northern Hemisphere and particularly in Europe in recent years ^[1].

Transmission

Francisella tularensis is spread by arthropods, airborne particles, and contaminated food or water, making it a multi-route zoonotic and vector-borne infection ^[1]. Its low infectious dose and facile airborne transmission underpin its designation as a category A agent ^[1]^[2]. A negative animal contact history can help exclude zoonotic pneumonia such as tularemia from diagnostic consideration ^[3].

Prevention

Control measures emphasize environmental and animal reservoir management alongside clear communication of clinical suspicion to laboratory personnel ^[1]. Postexposure prophylaxis is part of the preventive approach, although no safe and fully licensed vaccine is currently available and existing live vaccine strains are not approved for general use ^[1]^[2].

References

1 Antonello RM et al. Tularemia for clinicians: An up-to-date review on epidemiology, diagnosis, prevention and treatment. Eur J Intern Med. 2025 May. PMID: 40107886. doi: 10.1016/j.ejim.2025.03.013. PubMed: https://pubmed.ncbi.nlm.nih.gov/40107886/
2 Putzova D et al. Tularemia vaccines. Folia Microbiol (Praha). 2016 Nov. PMID: 27194547. doi: 10.1007/s12223-016-0461-z. PubMed: https://pubmed.ncbi.nlm.nih.gov/27194547/
3 Cunha BA et al. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006 May. PMID: 16669925. doi: 10.1111/j.1469-0691.2006.01393.x. PubMed: https://pubmed.ncbi.nlm.nih.gov/16669925/
4 Fleck-Derderian S et al. Systematic Review of Tularemia During Pregnancy. Clin Infect Dis. 2024 Jan 31. PMID: 38294114. doi: 10.1093/cid/ciad686. PubMed: https://pubmed.ncbi.nlm.nih.gov/38294114/
5 Asano S et al. Granulomatous lymphadenitis. J Clin Exp Hematop. 2012. PMID: 22706525. doi: 10.3960/jslrt.52.1. PubMed: https://pubmed.ncbi.nlm.nih.gov/22706525/