Tularemia (Rabbit Fever)

Tularemia is an illness caused by the bacteria francisella tularensis and ranges in manifestation from a skin ulcer with swollen lymph glands to septic shock with multiple organ failure and death. This bacterium is commonly associated with rabbits as a reservoir, but can also be seen in water rats, muskrats, voles, squirrels and beavers.

Where does it occur?

It is primarily seen in North America, Europe, China and Japan.

How is it transmitted?

The illness is commonly transmitted through the bite of ticks (wood tick, dog tick and lone star tick) and deer flies who acquire the bacteria from rabbits, water rats, muskrats, voles, squirrels and beavers.

One can also acquire the infection through inhaling bacteria or through cuts on the skin while handling infected animal tissue, hair, water or blood. Ingestion of infected meat of animals can also be responsible for causing infection.

Laboratory workers are at risk while handling bacterial cultures of the organism.

Is it contagious from person to person?

It is not contagious from person to person.

What is the risk for travelers?

The risk for travelers is low, unless engaged in hunting and handling of rabbits, squirrels, beavers etc.

How soon after exposure will one develop symptoms?

Symptoms usually develop in 3-5 days, but can be up to 14 days after exposure.

What are the signs and symptoms?

Signs and symptoms depend on the kind of illness that develops and are as described below.

Ulceroglandular illness: The area of skin where the bite or injury took place develops a boil or lump that ruptures and results in an ulcer with surrounding redness. One also develops painful and swollen lymph nodes in the region close to the ulcer.

Glandular illness: The area of skin bite or injury is not evident and has no boils or ulcers, but there are swollen and painful lymph nodes in the region.

Oculoglandular illness: The bacteria enter the body through the membranes of the eye by splash of liquid, airborne contact or scratching one’s eyes with infected hands. The eyes become swollen, red, draining pus and may have small ulcers or boils. Lymph nodes around the neck and jaw become swollen and painful.

Pneumonic illness: Pneumonia is commonly seen as a result of inhaling bacteria through activities of skinning animals, shearing sheep or laboratory procedures. Symptoms are of cough, fever, shortness of breath and chest pain.

Typhoidal illness: When the bacteria spreads from the skin or rapidly enters the bloodstream due to a large volume of exposure, one can see an illness with involvement of multiple organs characterized by fever, chills, body aches, headaches, nausea, vomiting, diarrhea, abdominal pain and shock which can lead to death.

Are there any lab tests to diagnose the illness?

The bacteria can be cultured from body fluids, but this is cumbersome and laboratory workers need to be warned about the bacteria and its danger.

Blood Antibody tests (IgM/IgG) are available as well.

This disease is rapidly fatal and initial diagnosis should be based on a high index of suspicion based on symptoms and history of exposure to ticks rabbits etc.

Is there any treatment?

Antibiotics like streptomycin, gentamicin and ciprofloxacin are effective for treatment.

What preventive measures can be taken?

Avoid tick bites and be extremely careful in handling of rabbits, beavers, squirrels and rats.

advice for your illness and travel
learn about an exotic disease