Tularaemia (rabbit fever, deer fly fever, Ohara's disease) is a highly infectious zoonotic disease caused by Francisella tularensis — one of the most infectious bacteria known (fewer than 10 organisms can cause inhalation disease). It primarily infects wild animals (particularly hares, rabbits, rodents and muskrats) — transmitted to humans through tick/deer fly bites, direct contact with infected animals, inhalation of contaminated material or ingestion of contaminated water/meat. Tularaemia is both a natural zoonosis and a Category A bioterrorism agent.

What are the clinical forms of tularaemia?

Six clinical forms depending on exposure route: Ulceroglandular (most common, approximately 75%): skin ulcer + painful regional lymphadenopathy — from tick/fly bites or animal contact. Glandular (approximately 10%): lymphadenopathy without ulcer. Oculoglandular (approximately 1-2%): conjunctivitis + preauricular lymphadenopathy — from eye inoculation. Oropharyngeal (approximately 5%): sore throat, cervical lymphadenopathy — from contaminated water/food. Pneumonic (approximately 10%): severe pneumonia — from inhalation; most dangerous. Typhoidal/septicaemic: systemic illness without localising features; high mortality.

How is tularaemia transmitted?

Multiple transmission routes: tick bites (Ixodes, Dermacentor — the most common natural transmission route in Europe and North America); deer fly (Chrysops) bites; direct contact with infected animals (particularly skinning, gutting or handling rabbits, hares and rodents — high-risk occupation for hunters, wildlife workers, veterinarians, trappers); inhalation of contaminated dust/aerosols (from mowing near infected carcasses, laboratory handling); ingestion of contaminated water or undercooked infected meat. F. tularensis does NOT spread person-to-person.

How is tularaemia treated?

First-line treatment: gentamicin IV/IM for 10-14 days (achieves superior bactericidal effect in intracellular organisms). Alternatives: streptomycin (historical standard, less available); doxycycline or ciprofloxacin (for mild disease, oral; used for post-exposure prophylaxis). Duration: 14 days minimum for pneumonic tularaemia. Post-exposure prophylaxis (after potential bioterrorism exposure): 14 days of doxycycline or ciprofloxacin. Relapse risk if treatment is insufficient — complete the full course.

Is tularaemia present in Georgia?

Georgia is in the geographic range of Francisella tularensis holarctica (Type B) — the Eurasian subspecies with lower virulence than North American Type A but still causing significant illness. Tularaemia has been documented in hares, rodents and water voles in the Caucasus region. Human cases have occurred in neighbouring countries (Turkey has significant tularaemia burden, especially the oropharyngeal form from contaminated water). PHIG monitors zoonotic diseases including tularaemia. Clinicians in Georgia should consider tularaemia in cases of prolonged fever with lymphadenopathy in hunters, farmers or those with tick exposure.

Why is tularaemia a bioterrorism concern?

F. tularensis Type A is one of the most dangerous potential bioterrorism agents: extremely low infectious dose by inhalation (<10 organisms); potential for large-area aerosol release; causes severe, potentially fatal pneumonia in previously healthy people; the delay between exposure and symptoms (3-5 days) would allow undetected dispersal before cases appear; mass casualties could overwhelm healthcare systems; and the former Soviet Union maintained a large tularaemia bioweapon programme. US preparedness: strategic national stockpile of antibiotics for post-exposure prophylaxis.

How does GMJ News cover tularaemia?

GMJ News covers WHO tularaemia data, ECDC European surveillance, F. tularensis bioterrorism preparedness, clinical forms and differential diagnosis, treatment evidence, Caucasus-specific risk, and tick-borne disease prevention. Tularaemia is directly relevant to Georgian occupational health and tick-borne disease surveillance — relevant to PHIG's One Health and health security mandate.

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Tularaemia

Q: How does GMJ News cover tularaemia?

GMJ News covers WHO tularaemia data, ECDC European surveillance, F. tularensis bioterrorism preparedness, clinical forms and differential diagnosis, treatment evidence, Caucasus-specific risk, and tick-borne disease prevention. Tularaemia is directly relevant to Georgian occupational health and tick-borne disease surveillance — relevant to PHIG's One Health and health security mandate.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Tularaemia — caused by Francisella tularensis, an obligate intracellular bacterium transmitted through tick bites, deer fly bites, contact with infected animals (particularly rabbits and hares), and environmental exposure — causes six distinct clinical syndromes ranging from the most common ulceroglandular form (painful ulcer + regional lymphadenopathy) to the most dangerous pneumonic form (inhalation anthrax-like), with approximately 500-1,000 cases per year reported globally but true burden vastly underestimated (WHO). Tularaemia is a CDC Category A bioterrorism agent because it is extremely infectious (fewer than 10 organisms can cause disease by the airborne route) and causes severe illness. The Caucasus region including Georgia has documented tularaemia in wildlife and human cases, making it directly relevant to regional public health.

Key messages

Category A bioterrorism + natural zoonosis

Tularaemia is simultaneously a natural zoonosis (from infected rabbits, hares, rodents and ticks) and a CDC Category A bioterrorism agent — because F. tularensis is one of the most infectious bacteria known (fewer than 10 organisms cause disease by inhalation) and causes severe illness.

Six clinical forms — ulceroglandular most common

Tularaemia presents in six clinical forms depending on exposure route: ulceroglandular (most common — skin ulcer + regional lymphadenopathy); glandular; oculoglandular; oropharyngeal; pneumonic (most dangerous); and typhoidal (septicaemic).

Caucasus relevance

Tularaemia is endemic in parts of the South Caucasus including Georgia — with documented cases in hares, rodents and occasionally in humans. Tick exposure and contact with wild rabbits/hares in rural Georgia creates ongoing transmission risk.

Gentamicin or doxycycline treatment

Tularaemia is effectively treated with gentamicin (first-line), doxycycline or ciprofloxacin. Streptomycin was the historical standard. The pneumonic form requires immediate treatment — delay is associated with very high mortality.

Tick and deer fly vectors

Tularaemia is transmitted by Ixodes and Dermacentor tick bites, Chrysops deer fly bites, direct animal contact (especially hares, rabbits), inhalation of contaminated dust, and consumption of infected water or undercooked meat.

F. tularensis Type A most lethal

Two main types: Type A (F. tularensis subsp. tularensis — North America; more virulent, higher case fatality) and Type B (F. tularensis subsp. holarctica — widespread in Eurasia, less virulent). Georgia/Caucasus cases are typically Type B.

Key statistics

500-1K

reported tularaemia cases/year globally (vastly underreported)

WHO

<10

F. tularensis organisms sufficient to cause inhalation disease

WHO/CDC

Category A

CDC bioterrorism classification

CDC/WHO

5-30%

case fatality rate for untreated pneumonic tularaemia

WHO

<1%

case fatality rate with antibiotic treatment

WHO

Georgia

documented tularaemia in wildlife and historical human cases

WHO/ECDC

Tularaemia in Europe — reported cases by country (2017-2022 average) — ECDC

Source: ECDC. Scandinavia, Turkey and Central Europe have highest European case burdens.

Glossary of key terms

Francisella tularensis
WHOA Gram-negative, obligate intracellular coccobacillus — one of the most infectious bacteria known. Type A (tularensis) — North America, higher virulence. Type B (holarctica) — Eurasia and North America, less virulent. Type A: ID50 by inhalation approximately 10 organisms; Type B: higher ID50.

Ulceroglandular tularaemia
WHO/ClinicalThe most common form — from tick or deer fly bites, or direct contact with infected animal tissue. Presents with a painful papule at the inoculation site → ulcerates with punched-out appearance → regional lymph node enlargement (may suppurate). Combined with fever, headache, myalgia. Responds well to antibiotics.

Pneumonic tularaemia
WHO/CDCCaused by inhalation of F. tularensis aerosols (laboratory exposure, aerosolised in bioterrorism, or from mowing/farming near infected animal carcasses). Presents as severe atypical pneumonia — high fever, productive cough, chest pain, rapidly progressive. The most dangerous form — case fatality 30-60% untreated; requires immediate treatment. A bioterrorism attack scenario causing pneumonic tularaemia in urban populations is a major preparedness concern.

Gentamicin
WHO EML/IDSAThe recommended first-line treatment for tularaemia — IV/IM gentamicin (5mg/kg/day) for 10-14 days. Aminoglycoside bactericidal action; superior to tetracyclines (bacteriostatic). Historical standard: streptomycin (now less available). Alternative: doxycycline or ciprofloxacin (oral — useful for mild disease and post-exposure prophylaxis).

F. tularensis as bioterrorism agent
CDC/WHOCategory A bioterrorism agent because: extremely low infectious dose (<10 organisms by inhalation); aerosol potential; causes severe, potentially fatal disease; would cause widespread panic and healthcare system overload. Former Soviet Union maintained extensive tularaemia bioweapon programme (Biopreparat). Post-exposure prophylaxis: doxycycline or ciprofloxacin for 14 days.

Serological diagnosis
ECDC/WHOStandard diagnosis: tube agglutination (TA) or microagglutination (MA) for F. tularensis antibodies — titres ≥1:160 are diagnostic. Antibodies appear 2 weeks after onset; peak 4-5 weeks. Culture (on special media — Thayer-Martin or BCYE agar; BSL-3 lab required due to infectivity). PCR (blood, tissue, swabs) — increasingly used. Clinical diagnosis with empirical treatment is appropriate in endemic areas.

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