An illness characterized by several distinct forms, including:
Ulceroglandular: cutaneous ulcer with regional lymphadenopathy
Glandular: regional lymphadenopathy with no ulcer
Oculoglandular: conjunctivitis with preauricular lymphadenopathy
Intestinal: pharyngitis, 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
Isolation of F. tularensis from a clinical specimen,
or
Demonstration of F. tularensis in a clinical specimen
by immunofluorescence, or
Fourfold or greater rise in agglutination titer between acute-
and convalescent-phase serum specimens obtained greater than or equal to 2
weeks apart, analyzed at the same time, and in the same laboratory
Case classification
Probable: a clinically compatible
case with supportive serologic results (tularemia agglutination titer of greater
than or equal to 160 in one or more serum specimens obtained after onset of symptoms)