An illness characterized by several distinct forms, including the
following:
Ulceroglandular: cutaneous ulcer with regional lymphadenopathy
Glandular: regional lymphadenopathy with no ulcer
Oculoglandular: conjunctivitis with preauricular lymphadenopathy
Oropharyngeal: stomatitis or pharyngitis or tonsillitis
and cervical lymphadenopathy
Intestinal: intestinal pain, vomiting, and diarrhea
Pneumonic: primary pleuropulmonary disease
Typhoidal: febrile illness without early localizing
signs and symptoms
Clinical diagnosis is supported by evidence or history of a
tick or deerfly bite, exposure to tissues of a mammalian host of Francisella
tularensis, or exposure to potentially contaminated water.
Laboratory criteria for diagnosis
Presumptive
Elevated serum antibody titer(s) to F. tularensis
antigen (without documented fourfold or greater change) in a patient with
no history of tularemia vaccination or
Detection of F. tularensis in a clinical specimen
by fluorescent assay
Confirmatory
Isolation of F. tularensis in a clinical specimen
or
Fourfold or greater change in serum antibody titer to F.
tularensis antigen
Case classification
Probable: a clinically compatible
case with laboratory results indicative of presumptive infection
Confirmed: a clinically compatible case with confirmatory
laboratory results