Tularemia (Francisella tularensis)
Reportable by Providers and LaboratoriesAbout this Reportable Disease
Infectious agent: Francisella tularensis
Description of illness: Tularemia is caused by Francisella tularensis bacteria; rabbits, hares, and rodents are the natural hosts. Humans and pets can become infected through direct exposure to infected animals, exposure to tissues or feces of infected animals, or via tick or deerfly bites. F. tularensis is highly infectious and can enter the body through the skin, eyes, mouth, or lungs. The symptoms of tularemia usually appear 3–5 days after exposure, and vary depending on the route of infection. Illness ranges from mild to life-threatening, and all forms of tularemia are accompanied by fever and swelling of the lymph glands. The most common forms are: ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic, and typhoidal. Tularemia is not known to spread from person to person.
Interactive Disease Data
Laboratory Reporting for this Disease
Francisella tularensis
| TEST NAME | Francisella tularensis | |
| DISEASE/DISORDER | Rabbit Fever | |
| ALTERNATE NAME(S) | ||
| METHODOLOGY | LRN-B Francisella tularensis PCR/ 7500DX | |
| SPECIAL INSTRUCTIONS |
|
|
| ORDERING INFORMATION | Lab Web Portal TDH DLS Requisition: PH-4263 Clinical Select Agent Rule-Out Submission Requisition |
Specimen Requirements
| Patient Preparation |
|
|
| Specimen Collection |
- Culture isolate - Clinical swabs - Lymph node aspirates - Tissue/biopsy - Bronchial or tracheal washings - Blood - Pleural fluid |
|
| Specimen Labeling |
|
|
| Specimen Processing |
|
|
| Specimen Storage and Preservation |
|
|
| Specimen Transport |
|
|
| Specimen Acceptability and Rejection |
|
|
| Testing Location |
|
Laboratory Reporting
Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.
- Manually report results to TDH by faxing or mailing a completed PH-1600 form to your local health department, or faxing to the state health office at (615) 741-3857
- Automatically submit results to TDH via electronic laboratory reporting (ELR), which automates the process of sharing data with TDH using interoperability standards.
- See the ELR Onboarding Handbook for details on the onboarding process, checklist, frequently asked questions, business rules, message format, and vocabulary.
- To initiate the ELR onboarding process with TDH, register in the Trading Partner Registration (TPR) system TPR provides documentation for Promoting Interoperability (PI) attestation and milestone letters to document onboarding progress. Contact MU.Health@tn.gov for assistance.
- Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
- Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for Healthcare Providers
Clinical Summary
It’s a zoonotic, highly infectious bacterial illness transmitted via tick/deer-fly bites, animal contact, ingestion of contaminated water/food, or inhalation of aerosols.
Incubation is typically 3-5 days, then sudden onset of fever, chills, headache, fatigue and myalgias.
The most common form is ulceroglandular: a skin ulcer at the entry site plus tender regional lymphadenopathy; other forms involve the eye, throat (oropharyngeal), lungs (pneumonic) or systemic (typhoidal).
Diagnosis is based on exposure history, clinical presentation and supportive labs (serology, culture/PCR); the bacterium is highly infectious even with very low dose exposure.
Treatment requires prompt appropriate antibiotics (e.g., aminoglycosides, fluoroquinolones, doxycycline) and prevention focuses on vector/animal contact reduction and safe water/food practices.
Healthcare Provider Reporting
Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.
Providers must report cases of all diseases and conditions listed through one of these methods:
• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857
• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.
• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for the Public
What It Is
Tularemia is a zoonotic bacterial infection (i.e., transmitted from animals to humans) caused by Francisella tularensis. The bacterium is very infectious: a small number of organisms can cause disease. It can enter the body via several routes — skin breaks, the eyes, mouth/throat, inhalation — and then cause illness varying by entry route.
Types
The form of tularemia depends largely on how the bacteria enter the body and where the infection develops. Key types include:
Ulceroglandular: The most common form. Entry via a tick bite or animal contact leads to a skin ulcer at the entry site + swollen regional lymph nodes.
Glandular: Similar to ulceroglandular but without a visible skin ulcer; mainly involves lymph nodes.
Oculoglandular: The infection enters via the eye (e.g., contaminated fluid enters the eye); you get conjunctivitis + lymph node swelling around the ear/neck.
Oropharyngeal: From ingestion of contaminated food/water or contamination of the mouth/throat; symptoms include throat pain, mouth ulcers, tonsillitis, neck lymphadenopathy.
Pneumonic: From inhalation of the bacteria (or spread to the lungs from another site). Most serious form: cough, chest pain, difficulty breathing.
Typhoidal: A systemic form without a clear localized entry site; high fever, general illness, may involve many organs.
Signs and Symptoms
Sudden onset of high fever, chills, headache, muscle aches, and profound fatigue.
In skin-entry cases (ulceroglandular/glandular): a painful skin ulcer at the entry site with swollen, tender regional lymph nodes.
If infection involves the eye (oculoglandular): redness, tearing, pain, sometimes an ulcer in the eye, and nearby lymph-node swelling.
With throat/ingestion route (oropharyngeal): sore throat, mouth ulcers or tonsillitis, swollen neck nodes, possible vomiting/diarrhea.
In lung/inhalation cases (pneumonic/typhoidal): cough (dry or productive), chest pain, shortness of breath, and sometimes systemic signs like weight loss or abdominal pain.
Treatment
Prompt treatment improves outcomes. Key points:
First‐line therapy for severe cases: an aminoglycoside (e.g., Gentamicin or Streptomycin) for 10-14 days.
Alternatives (or in less severe cases): Ciprofloxacin (a fluoroquinolone) or Doxycycline for 14-21 days, depending on severity/form.
Some older agents (like tetracyclines) work but have higher relapse rates, so they’re less preferred.
Some forms may require adjunctive care: draining of lymph nodes, supportive care (fluids, analgesics) etc.
This Page Last Updated: March 25, 2026 at 8:53 PM