Epidemiology and Management of Tularemia
Summary
Tularemia is a zoonotic infection caused by the Gram-negative, facultative intracellular bacterium Francisella tularensis. It occurs throughout the Northern Hemisphere, with natural reservoirs in lagomorphs, rodents and arthropod vectors such as ticks, deer flies and, in certain regions, mosquitoes. Human cases arise via direct contact with infected animals, arthropod bites, inhalation of contaminated aerosols or ingestion of contaminated water or food. Clinical presentations range from ulceroglandular and glandular forms to pneumonic, oculoglandular and typhoidal disease, with severity influenced by subspecies and route of exposure. Surveillance data show seasonal and geographic clustering linked to ecological factors, notably proximity to water bodies that support vector and reservoir populations. Management relies on early recognition, laboratory confirmation by culture, molecular methods or serology, and prompt antimicrobial therapy. Aminoglycosides remain first-line for severe cases, while fluoroquinolones and tetracyclines offer effective oral alternatives. Surgical intervention may be required for suppurative lymphadenitis or invasive complications. A One Health approach integrating human, veterinary and environmental surveillance enhances outbreak detection and control. Ongoing research into vaccine candidates and rapid diagnostics aims to fortify preparedness against both natural and deliberate releases of this high-risk pathogen.
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Epidemiology and Management of Tularemia publication trend
The graph below shows the total number of articles in epidemiology and management of tularemia across all publications each year (not limited to Nature Index journals).
Technical terms
Zoonosis: Infection naturally transmitted between animals and humans.
Francisella tularensis: A highly infectious, facultative intracellular bacterium responsible for tularemia.
Ulceroglandular tularemia: The most common form, characterised by a skin ulcer at the site of entry and swollen regional lymph nodes.
Fluoroquinolones: A class of broad-spectrum antibiotics effective against intracellular pathogens and useful as oral therapy.
Seroprevalence: The proportion of individuals in a population with detectable specific antibodies indicating exposure.
References
- Tularemia Clinical Manifestations, Antimicrobial Treatment, and Outcomes: An Analysis of US Surveillance Data, 2006–2021. Clinical Infectious Diseases (2024).
- Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection - Volume 29, Number 6—June 2023 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2023).
- Tularemia as a waterborne disease: a review. Emerging Microbes & Infections (2019).
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