Key points
- Tularemia is caused by infection with the bacteria Francisella tularensis.
- Transmission routes are multiple and include tick bite, deer fly bite, inhalation, ingestion, and skin contact with infected animals. In addition, people could be exposed as a result of bioterrorism.
Prophylaxis
- Tularemia post-exposure prophylaxis is recommended in cases of occupational exposure to infectious materials. Doxycycline (100 mg orally BID X 10-14 days) is recommended for prophylaxis in adults, as well as ciprofloxacin (500 mg orally BID X 7 days) and levofloxacin (500 mg orally daily X 7 days).
- Vaccination for tularemia is not generally available in the United States, nor is it useful to manage sick patients.
Infection control and environmental decontamination
- Standard precautions are recommended in hospitals. Isolation is not recommended for patients with tularemia because there is no person-to-person transmission.
- Laboratory personnel should be alerted when tularemia is suspected. Standard diagnostic procedures with clinical materials can be performed in biosafety level 2 conditions. All work with suspect cultures of F. tularensis should be performed in a biological safety cabinet. Manipulation of cultures and other procedures that might produce aerosols or droplets (e.g., grinding, centrifuging, or vigorous shaking) should be conducted under biosafety level 3 conditions.
- Bodies of patients who die of tularemia should be handled using standard precautions and personal protective equipment.
- Clothing or linens contaminated with body fluids of patients with tularemia should be disinfected per standard hospital procedure.