Deer flies, mosquitoes, ticks, and direct contact with infected animal tissue can transmit the disease.
+The most common manifestation is an atypical pneumonia and leukopenia.
+Person-to-person contact is common, and family members should be offered prophylaxis.
+Oral tetracycline for a minimum of 2 weeks is the treatment of choice.
+Many patients experience a Jarisch-Herxheimer reaction after appropriate treatment.
Tularemia, a systemic disease caused by Francisellatularensis, is most often contracted during the summer as a result of tick bites. However, it has also been linked to the handling of infected rabbit carcasses and to contact with infected domesticated cats and dogs. The disease is not transmitted via person-to-person contact. There are six clinical presentations, depending on whether the symptoms are localized to the entry site, regionally invasive, or systemic. The most common is ulceroglandular fever in which an indurated ulceration at the site of inoculation develops with local lymphadenopathy. Glandular tularemia, the second most common type, is characterized by marked lymphadenopathy without the accompanying skin lesion. Oculoglandular tularemia is rare, but can result in conjunctivitis and corneal perforation. The most severe form is pneumonic tularemia, which has a case-fatality rate of up to 30%. Treatment for tularemia is with streptomycin IM bid for 7–14 days. Gentamicin may be used as an alternative. Infection generally results in life-long immunity. A vaccine is available that can be offered to high-risk patients to decrease the severity of infection, but it is not totally effective in preventing the illness.