Tularemia: A Comprehensive Guide
Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on April 10th, 2026.
Published on April 10th, 2026. Updated on August 24th, 2026.
Key Takeaways
Tularemia is a rare bacterial infection caused by Francisella tularensis, often called "rabbit fever"
The disease spreads through contact with infected animals, tick bites, or contaminated water and soil
Symptoms vary by infection type but commonly include fever, swollen lymph nodes, and skin ulcers
Early antibiotic treatment is highly effective and prevents serious complications
Prevention focuses on avoiding infected animals and using tick protection in endemic areas
Overview
Tularemia is a bacterial infection caused by Francisella tularensis. This disease is also known as "rabbit fever" because it commonly affects rabbits and other small mammals. The bacteria can infect humans through several pathways, making it an important zoonotic disease.
This condition occurs worldwide but is most common in rural areas of North America, Europe, and Asia. In the United States, about 200 cases are reported each year, with most occurring in Arkansas, Missouri, and Oklahoma. The infection can affect people of all ages, but it's more frequently seen in hunters, veterinarians, and others who work closely with animals.
Tularemia matters because without treatment, it can cause serious complications. However, with proper antibiotic therapy, most people recover completely. Understanding the causes and symptoms helps people recognize the infection early and seek appropriate care.
The disease got its name from Tulare County in California, where it was first discovered in ground squirrels in 1911. Scientists learned that humans could catch this sickness from infected animals and insects. Today, doctors know how to treat tularemia quickly and effectively with the right antibiotics.
Symptoms & Signs
The symptoms of tularemia vary depending on how the bacteria enters your body and which organs it affects. Most people develop symptoms within 3 to 5 days after exposure, though it can take up to 14 days.
Primary Symptoms
Sudden fever and chills - High fever (often over 101°F) that comes on quickly with severe chills
Swollen lymph nodes - Painful, enlarged lymph glands, especially in the neck, armpit, or groin area
Skin ulcer at infection site - A painful sore that develops where bacteria entered through broken skin
Severe fatigue and weakness - Extreme tiredness that interferes with daily activities
Headache and muscle aches - Intense head pain often accompanied by body aches and joint pain
When to Seek Care
Watch for signs that the infection is spreading or getting worse. Difficulty breathing, chest pain, or coughing up blood suggests lung involvement. Severe abdominal pain or persistent vomiting may indicate internal organ infection.
Some people develop a specific type called "glandular tularemia" with only swollen lymph nodes. Others get "ulceroglandular tularemia" which causes skin sores plus swollen glands. A third type affects the lungs and causes coughing and chest pain. The type you get depends on how the bacteria entered your body.
When to Seek Immediate Care
Seek prompt medical care if you develop fever or other symptoms after possible exposure to tularemia. Call emergency services or go to an emergency department for difficulty breathing, severe chest pain, coughing up blood, confusion, fainting, or other severe symptoms.
Causes & Risk Factors
Tularemia spreads through direct contact with infected animals or their environment. The bacteria can survive for weeks in water, soil, and decaying animal carcasses, creating multiple exposure opportunities.
The most common cause is handling infected rabbits, hares, or rodents. The bacteria can enter through small cuts in the skin or through mucous membranes in the eyes, nose, or mouth. Tick and deer fly bites also transmit the disease, particularly in wooded areas during warm months.
Contaminated water sources and soil pose additional risks. People can become infected by drinking untreated water from streams or wells in areas where infected animals have died. Breathing dust from contaminated soil or animal bedding can also lead to the lung form of tularemia.
Hunters who field dress wild game without protection face high risk of infection. Gardeners who touch infected rabbit droppings or dead animals can get sick too. Even brushing against infected rabbit fur can cause infection if you have small cuts on your hands or arms.
Age
All ages affected, but outdoor workers and hunters at higher risk
Genetics
No known genetic predisposition to tularemia infection
Lifestyle
Hunting, farming, landscaping, and outdoor recreation increase exposure
Other Conditions
Immune system disorders may increase severity
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Diagnosis
Diagnosing tularemia requires careful attention to both symptoms and potential exposure history. Early diagnosis is important because symptoms can mimic other infections, and prompt treatment prevents complications.
Medical History & Physical Examination
Your doctor will ask detailed questions about recent activities, including hunting, gardening, tick bites, or contact with wild animals. They'll also want to know about travel to rural areas or consumption of untreated water. During the physical exam, your doctor will check for swollen lymph nodes, skin ulcers, and signs of organ involvement like lung or eye inflammation.
Diagnostic Testing
Blood tests - Check for antibodies against tularemia bacteria and signs of infection like elevated white blood cell count
Culture samples - Grow bacteria from blood, sputum, or wound samples, though this takes several days
PCR testing - Rapidly detect bacterial DNA in blood or tissue samples for faster diagnosis
Chest X-ray - Identify lung involvement in cases of respiratory tularemia
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Treatment Options
The goal of tularemia treatment is to eliminate the bacteria and prevent complications. Most people respond well to antibiotic therapy when treatment starts early.
Conservative Treatments
Streptomycin or gentamicin - Injectable antibiotics that may be used for severe tularemia; the choice and treatment duration depend on the infection type, severity, and patient factors
Gentamicin therapy - An injectable antibiotic commonly used for severe tularemia when an aminoglycoside is appropriate
Supportive care - Rest, fluids, and fever management while antibiotics work to clear the infection
Advanced Treatments
Doxycycline or ciprofloxacin - Antibiotics that may be used in selected cases, depending on disease severity, infection type, patient factors, and local guidance
Hospitalization - Required for severe cases with breathing problems, widespread infection, or complications
Drainage procedures - Surgical drainage of large, infected lymph nodes that don't respond to antibiotics
Similar to other serious bacterial infections, proper antibiotic selection is crucial for effective treatment.
Treatment must start quickly to work best against tularemia bacteria. Antibiotics should be started promptly once tularemia is suspected, but treatment can still be effective when diagnosis is delayed. Treatment duration depends on the antibiotic, infection type, severity, and response to therapy and may extend beyond 14 days. Follow the prescribing clinician's instructions closely.
Living with the Condition
Most people with tularemia recover completely with proper treatment. However, fatigue and weakness may persist for several weeks after other symptoms resolve.
Daily Management Strategies
Take all prescribed antibiotics even if you feel better before finishing the course. Rest is important during recovery, as your body needs energy to fight the infection. Stay hydrated and eat nutritious foods to support your immune system. Monitor your temperature and watch for any return of symptoms that might indicate incomplete treatment.
Some people feel very tired even after the fever goes away. This fatigue can last for weeks, so be patient with your recovery. Eating healthy foods with protein and vitamins helps your body heal faster. Getting enough sleep is just as important as taking your medicine.
Exercise & Movement
Avoid strenuous activities until fever resolves and energy levels return to normal. Light walking is usually fine, but listen to your body and rest when needed. Recovery time varies. Return to activity gradually as fever, breathing symptoms, and fatigue improve, and ask your healthcare provider about persistent or worsening symptoms. However, those who had severe lung involvement may need longer recovery time.
You might feel frustrated by how tired you get during recovery. This is normal and expected, and your strength will return with time. Gradually increase your activity as you feel better, but don't push too hard. Talk to your doctor if you're still very tired after three weeks of recovery.
Prevention
Wear protective gear - Use gloves and eye protection when handling wild animals, especially rabbits and rodents
Use insect repellent - Apply DEET-containing repellents to prevent tick and deer fly bites during outdoor activities
Check for ticks regularly - Examine your body and clothing after spending time in wooded areas
Cook wild game thoroughly to a safe internal temperature recommended for that type and cut of meat, using a food thermometer.
Avoid untreated water - Don't drink from streams, ponds, or wells in areas where tularemia is common
Maintain good hygiene - Wash hands thoroughly after any contact with animals or outdoor environments
Understanding lifestyle factors that support overall health can help your body resist infections.
Being careful around wildlife is the best way to avoid tularemia. Wash your hands with soap and water right after being outside or handling animals. Never touch dead animals with bare hands, even if they look harmless. When you spend time hunting or gardening, wear long sleeves and pants to protect your skin from bites and scratches.
Frequently Asked Questions
No, tularemia is not known to spread from person to person. Infection can occur through infected animals or arthropod bites, contaminated food or water, or inhalation of contaminated dust or aerosols. Family members of infected patients are not at risk unless they had the same exposure.
Many people begin improving after effective antibiotics, but the timing varies. Full recovery may take several weeks or longer, especially after severe illness, and persistent or worsening symptoms should be discussed with a healthcare provider. Without treatment, the disease can persist for months and cause serious complications.
Yes, tularemia and rabbit fever are the same disease. It's called rabbit fever because rabbits are commonly affected animals, but the infection can spread from many different animal species including squirrels, beavers, and cats.
Recovery may provide some lasting immunity, but reinfection can occur. Continue taking precautions against animal, tick, and environmental exposures because immunity may not be fully protective.
Cats and dogs can get tularemia, especially if they hunt or eat infected animals. If your pet shows signs of illness after contact with wild animals, consult your veterinarian. Keep pets away from sick or dead wildlife and ticks, and consult a veterinarian if a pet becomes ill after a possible exposure.
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