IMMEDIATELY REPORTABLE DISEASE: Any suspected case should be reported immediately by telephone to the Local Health Officer and by the Health Officer to the State Department of Health and Senior Services; include clinical and laboratory information supporting the diagnosis for appropriate investigation and control recommendations.

CLINICAL DESCRIPTION

A zoonotic bacterial illness characterized by several distinct clinical forms including:

1. Ulceroglandular (a cutaneous ulcer with swelling of the regional lymph nodes);
   
2. Glandular (swelling of regional lymph nodes without apparent ulcer);
   
3. Oculoglandular (conjunctivitis and swelling of preauricular lymph node);
   
4. Oropharyngeal (stomatitis or pharyngitis or tonsillitis and cervical lymphadenopathy)
   
5. Intestinal (pharyngitis, intestinal pain, vomiting and diarrhea);
   
6. Pneumonic (primary pleuropulmonary disease);
   
7. Typhoidal (febrile illness without early localized signs and symptoms).
   Clinical diagnosis is supported by evidence or history of a tick or a deerfly bite, exposure to tissue of a mammalian host of Francisella tularensis (e.g. rabbit), or exposure to potentially contaminated water. The incubation period ranges from 1 to 14 days, usually 3 to 5 days. It is not transmitted directly from person to person.

CASE CLASSIFICATION

1. CONFIRMED

A clinically compatible case and one or more of the following laboratory results:

• A fourfold or greater change in serum antibody titer to Francisella tularensis antigen; OR
  
• Isolation of Francisella tularensis from a clinical specimen.
  NOTE: Francisella tularensis may be hazardous to laboratory workers.
  
  
2. PROBABLE
   
   A clinically compatible case and one or more of the following laboratory results:
   • Elevated serum antibody titer to Francisella tularensis antigen (without documented fourfold or greater change) in a patient without history of tularemia vaccination OR
     
   • Detection of Francisella tularensis in a clinical specimen by fluorescent assay.
     
     
3. POSSIBLE
   
   Initially reported on the basis of clinical diagnosis, until confirmation is obtained; no possible case classifications are retained.

What you should know about Tularemia?