• Richard B. Hornick


Tularemia is a rare infectious disease caused by a small pleomorphic, gram-negative rod, Francisella tularensis. Patients who acquire the disease have symptoms and signs that relate to the portals of entry of the bacteria: oculoglandular, ulceroglandular, pneumonic, and typhoidal. This infectious disease has been thoroughly studied through induced infections in volunteers; hence, a considerable body of data has been accumulated in a quantitative fashion about the pathogenicity of tularemia bacilli in humans. Man appears to be one of the most susceptible mammalian hosts studied: fewer than 50 organisms can cause disease whether administered intradermally or by the respiratory route.(45) The usual sources of infections are animals, especially cottontail rabbits, voles, and muskrats. Humans acquire the disease by direct contact or by bites of the ticks, mosquitoes, deerflies, and other insects that infest such animals. An effective vaccine, unique for bacterial infections because it consists of a live attenuated strain, has been developed . (10)


Pneumonia Bacillus Flare Streptomycin Meningitis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alexander, M. M., Wright, G. G., and Baldwin, A. C., Observations on the agglutination of polysaccharide-treated erythrocytes by tularemia antisera, J. Exp. Med. 91:561–566 (1950).PubMedCrossRefGoogle Scholar
  2. 2.
    Barbeito, M. S., Alg, R. L., and Wedum, A. G., Infectious bacterial aerosol from dropped petri dish cultures, Am. J. Med. Technol. 27:318–322 (1961).PubMedGoogle Scholar
  3. 3.
    Bell, J. F., Ecology of tularemia in North America, J. Jinsen Med. 11:33–44 (1965).Google Scholar
  4. 4.
    Bellanti, J. A., Beuscher, E. L., Brandt, W. E., Dangerfield, H. G., and Crozier, D., Characterization of human serum and nasal hemagglutinating antibody to Francisella tularensis, J. Immunol. 98:171–178 (1967).Google Scholar
  5. 5.
    Bivin, W. S., and Hogge, A. L., Jr., Quantitation of susceptibility of swine to infection with Pasteurella tularensis, Am. J. Vet. Res. 28:1619–1621 (1967).Google Scholar
  6. 6.
    Buchanan, T. M., Brooks, G. F., and Brachman, P. S., The tularemia skin test-325 skin tests in 210 persons: Serologic correlation and review of the literature, Ann. Intern. Med. 74:336–343 (1971).PubMedGoogle Scholar
  7. 7.
    Burnett, T. W., Tularemia in a Rocky Mountain sector of the western front, Mil. Surg. 78:193–199 (1936).Google Scholar
  8. 8.
    Canonico, P. G., Mcmanus, A. T., Mangiafico, J. A., Sammons, L. S., Mcgann, V. G., and Dangerfield, H. G., Temporal appearance of opsonizing antibody to Francisella tularensis: Detection by a radiometabolic assay, Infect. Immun. 11:466–469 (1975).PubMedGoogle Scholar
  9. 9.
    Dahlstrand, S., Ringertz, O., and Zetterberg, B., Airborne tularemia in Sweden, Scand. J. Infect. Dis. 3:7–16 (1971).PubMedGoogle Scholar
  10. 10.
    Eigelsbach, H. T., and Downs, C. M., Prophylactic effectiveness of live and killed tularemia vaccines. I. Production of vaccine and evaluation in the white mouse and guinea pig, J. Immunol. 87:415–425 (1961).PubMedGoogle Scholar
  11. 11.
    Eigelsbach, H. T., Tulis, J. J., Mcgavran, M. H., and White, J. D., Live tularemia vaccine. I. Host-parasite relationship in monkeys vaccinated intracutaneously or aerogenically, J. Bacteriol. 84:1020–1027 (1962).PubMedGoogle Scholar
  12. 12.
    Eigelsbach, H. T., Hunter, D. H., Janssen, W. A., Dangerfield, H. G., and Rabinowitz, S. G., Murine model for study of cell-mediated immunity: Protection against death from fully virulent Francisella tularensis infection, Infect. Immun. 12:999–1005 (1975).PubMedGoogle Scholar
  13. 13.
    Evans, M. E., Gregory, D. W., Schaffner, W., and Mcgee, Z., Tularemia: A 30-year experience with 88 cases, Medicine 64:251–269 (1985).PubMedCrossRefGoogle Scholar
  14. 14.
    Francis, E., Deer-fly fever: A disease of man of hitherto unknown etiology, Public Health Rep. 34:2061–2062 (1919).CrossRefGoogle Scholar
  15. 15.
    Francis, E., The occurrence of tularemia in nature, as a disease of man, Public Health Rep. 36:1731 (1921).CrossRefGoogle Scholar
  16. 16.
    Francis, E., and Mayne, B., Experimental transmission of tularemia by flies of the species Chryops discalis, Public Health Rep. 36:1738–1746 (1921).Google Scholar
  17. 17.
    Gaiskii, N. A., Altareva, N. D., and Lennik, T. G., Rapidity of the appearance and length of persistence of immunity after vaccination with tularemia vaccine, in: History and Incidence of Tularemia in the Soviet Union A Review (R. Pollitzer, ed.), pp. 125–136, Institute of Contemporary Russian Studies, Fordham University, New York, 1967.Google Scholar
  18. 18.
    Gallivan, M. V. E., Davis, W. A., III, Garagusi, V. F., Paris, A. L., and Lack, E. E., Fatal cat-transmitted tularemia: Demonstration of the organism in tissue, South. Med. J. 73:240–242 (1980).PubMedCrossRefGoogle Scholar
  19. 19.
    Horne, H., En lemeng og marsvintest, Nor. Vet. Tidsskr. 23:16 (1911).Google Scholar
  20. 20.
    Hornick, R.B., and Eigelsbach, H. T., Aerogenic immunization of man with live tularemia vaccine, Bacteriol. Rev. 30:532–538 (1966).Google Scholar
  21. 21.
    Hornick, R. B., Dawkins, A. T., Eigelsbach, H. T., and Tulis, J. J., Oral tularemia vaccine in man, Antimicrob. Agents Chemother. 1966 pp. 11–14 (1967).Google Scholar
  22. 22.
    Hunt, J. S., Pleuropulmonary tularemia: Observations on 12 cases treated with streptomycin, Ann. Intern. Med. 26:263–276 (1947).PubMedGoogle Scholar
  23. 23.
    Jellison, W. L., and Parker, R. R., Rodents, rabbits and tularemia in North America: Some zoological and epidemiological considerations, Am. J. Trop. Med. 25:349–362 (1945).Google Scholar
  24. 24.
    Jellison, W. L., Owen, C. R., Bell, J. F., and Kohls, G. M., Tularemia and animal populations: Ecology and epizootiology, Wildl. Dis. 17 (1961).Google Scholar
  25. 25.
    Klotz, S. A., Penn, R. L., and Provenza, J. M., The unusual presentations of tularemia. Bacteremia, pneumonia and rhabdomyolysis, Arch. Intern. Med. 147:214 1987).PubMedCrossRefGoogle Scholar
  26. 26.
    Mccahan, G. R., Moody, M. D., and Hayes, F. A., An epizootic of tularemia among rabbits in northwestern South Carolina, Am. J. Hyg. 75:335–338 (1962).Google Scholar
  27. 27.
    McCoy, G. W., A plague-like disease of rodents, Public Health Bull. No. 43 (1911).Google Scholar
  28. 28.
    McCoy, G. W., and Chapin, C. W. , Bacterium tularense, the cause of a plague-like disease of rodents, Public Health Bull. No. 53 (1912).Google Scholar
  29. 29.
    Mcgavran, M. H., White, J. D., Eigelsbach, H. T., and Kerpsack, R. W., Morphologic and immunohistochemical studies of the pathogenesis of infection and antibody formation subsequent to vaccination of Macaca irus with an attenuated strain of Pasteurella tularensis. I. Intracutaneous vaccination, Am. J. Pathol. 41:259–271 (1962).PubMedGoogle Scholar
  30. 30.
    Miller, R. P., and Bates, J. H., Pleuropulmonary tularemia: A review of 29 patients, Am. Rev. Respir. Dis. 99:31–41 (1969).PubMedGoogle Scholar
  31. 31.
    Moe, J. B., Canonico, P. G., Stookey, J. L., Powanda, M. C., and Cockerell, G. L., Pathogenesis of tularemia in immune and nonimmune rats, Am. J. Vet. Res. 36:1505–1510 (1975).PubMedGoogle Scholar
  32. 32.
    Nutter, J. E., and Myrvik, W. N., In vitro interactions between rabbit alveolar macrophages and Pasteurella tularensis, J. Bacteriol. 92:645–651 (1966).Google Scholar
  33. 33.
    Ohara, S., The Story of Yato-Byo (Tularemia in Japan), Obama, Fukushima City, 1955.Google Scholar
  34. 34.
    Overholt, E. L., and Tigertt, W. D., Roentgenographic manifestations of pulmonary tularemia, Radiology 74:758–765 (1960).PubMedGoogle Scholar
  35. 35.
    Overholt, E. L., Tigertt, W. D., Kadull, P. J., Ward, M. K., Charkes, N. D., Rene, R. M., Saltzman, T. E., and Stephens, M., An analysis of forty-two cases of laboratory-acquired tularemia: Treatment with broad-spectrum antibiotics, Am. J. Med. 30:785 (1961).PubMedCrossRefGoogle Scholar
  36. 36.
    Owen, C. R., and Buker, E. O., Factors involved in the transmission of Pasteurella tularensis from inoculated animals to healthy cage mates, J. Infect. Dis. 99:227–233 (1956).CrossRefGoogle Scholar
  37. 37.
    Penn, R. L., and Kinsewitz, G. T., Factors associated with a poor outcome in tularemia, Arch. Intern. Med. 147:265–268 (1987).PubMedCrossRefGoogle Scholar
  38. 38.
    Philip, R. N., Huntley, B., Lackman, D. B., and Comstock, G. W., Serologic and skin test evidence of tularemia infection among Alaskan Eskimos, Indians and Aleuts, J. Infect. Dis. 110:220–230 (1962).PubMedCrossRefGoogle Scholar
  39. 39.
    Proctor, R. A., White, J. D., Ayala, E., and Canonico, P. G., Phagocytosis of Francisella tularensis by rhesus monkey peripheral leukocytes, Infect. Immun. 11:145–151 (1975).Google Scholar
  40. 40.
    Puntigam, F., Thorakale Formen in Seuchengeschehen der Tularämie in Österreich, Wien. Klin. Wochenschr. 72:813–816 (1960).PubMedGoogle Scholar
  41. 41.
    Riggs, J. L., Seiwald, R. J., Burckhalter, J. H., Downs, C. M., and Metcalf, T. G., Isothiocyanate compounds as fluorescent labeling agents for immune serum, Am. J. Pathol. 34:1081–1097 (1958).PubMedGoogle Scholar
  42. 42.
    Saslaw, S., and Carhart, S., Studies with tularemia vaccines in volunteers. Iii. Serologic aspects following intracutaneous or respiratory challenge in both vaccinated and nonvaccinated volunteers, Am. J. Med. Sci. 241:689–699 (1961).PubMedCrossRefGoogle Scholar
  43. 43.
    Saslaw, S., and Carlisle, H. N., Studies with tularemia vaccines in volunteers. Iv. Brucella agglutinins in vaccinated and nonvaccinated volunteers challenged with Pasteurella tularensis, Am. J. Med. Sci. 242:166–172 (1961).PubMedCrossRefGoogle Scholar
  44. 44.
    Saslaw, S., Eigelsbach, H. T., Wilson, H. E., Prior, J. A., and Carhart, S., Tularemia vaccine study. I. Intracutaneous challenge. Arch. Inter. Med. 107:689–701 (1961).CrossRefGoogle Scholar
  45. 45.
    Saslaw, S., Eigelsbach, H. T., Prior, J. A., Wilson, H. E., and Carhart, S., Tularemia vaccine study. II. Respiratory challenge, Arch. Intern. Med. 107:702–714 (1961).PubMedCrossRefGoogle Scholar
  46. 46.
    Sawyer, W. D., Jemski, J. V., Hogge, A. L., Jr., Eigelsbach, H. T., Wolfe, E. K. Dangerfield, H. G., Gochenour, W. S., Jr., and Crozier, D., Effect of aerosol age on the infectivity of airborne Pasteurella tularensis for Macaca mulatta and man, J. Bacteriol. 91:2180–2184 (1966).Google Scholar
  47. 47.
    Sil’Chenko, V. S., Epidemiological and clinical features of tularemia caused by waterborne infection, Zh. Mikrobiol. Epidemiol. Immunobiol. 28:788–795 (1957).Google Scholar
  48. 48.
    Stuart, B. M., and Pullen, R. L., Tularemic pneumonia: Review of American literature and report of 15 additional cases, Am. J. Med. Sci. 210:223–236 (1945).CrossRefGoogle Scholar
  49. 49.
    Tärnvik, A., and Löfgren, S., Stimulation of human lymphocytes by a vaccine strain of Francisella tularensis, Infect. Immun. 12:951–957 (1975).Google Scholar
  50. 50.
    Tärnvik, A., Sandström, G., and Löfgren, S., Time of lymphocyte response after onset of tularemia and after tularemia vaccination, J. Clin. Microbiol. 10:854–860 (1979).PubMedGoogle Scholar
  51. 51.
    Teutsch, S. M., Martone, W. J., Brink, E. W., Potter, M. E., Eliot, G., Hoxsie, R., Craven, R. B., and Kaufmann, A. F., Pneumonic tularemia on Martha’s Vineyard, N. Engl. J. Med. 301:826–828 (1979).PubMedCrossRefGoogle Scholar
  52. 52.
    Vail, D. T., Bacillus tularense infection of the eye, Ophthalmol. Res. 23:487 (1914).Google Scholar
  53. 53.
    Waring, W. B., and Ruffin, J. J., A tick-borne epidemic of tularemia, N. Engl. J. Med. 234:137 (1946).CrossRefGoogle Scholar
  54. 54.
    Wherry, W. B., A new bacterial disease of rodents transmissible to man, Public Health Rep. 29:3387 (1914).CrossRefGoogle Scholar
  55. 55.
    White, J. D., Mcgavran,M. H., Prickett, P. A., Tulis, J. J., and Eigelsbach, H. T., Morphologic and immunohistochemical studies of the pathogenesis of infection and antibody formation subsequent to vaccination of Macaca irus with an attenuated strain of Pasteurella tularensis. II. Aerogenic vaccination, Am. J. Pathol. 41:405–413 (1962).PubMedGoogle Scholar
  56. 56.
    Who, Annual Statistics, Infectious Diseases: Cases and Deaths 2:1–204 (1978).Google Scholar
  57. 57.
    Young, L. S., Bicknell, D. S., Archer, B. G., Clinton, J. M., Leavens, L. J., Feeley, J. C., and Brachman, P. S., Tularemia epidemic: Vermont, 1968: Forty-seven cases linked to contact with muskrats, N. Engl. J. Med. 280:1253–1260 (1969).PubMedCrossRefGoogle Scholar

Suggested Reading

  1. Boyce, J. M., Recent trends in the epidemiology of tularemia in the United States, J. Infect. Dis. 131:197–199 (1975).PubMedCrossRefGoogle Scholar
  2. Brooks, G. F., and Buchanan, T. M., Tularemia in the United States: Epidemiologic aspects in the 1960’s and followup of the outbreak of tularemia in Vermont, J. Infect. Dis. 121:357–359 (1970).PubMedCrossRefGoogle Scholar
  3. Butler, T., Plague and tularemia, Pediatr. Clin. North Am. 26:355–366 (1979).PubMedGoogle Scholar
  4. Jellison, W. L., Owen, C. R., Bell, J. F., and Kohls, G. M., Tularemia and animal populations: Ecology and epizootiology, Wildl. Dis. 17 (1961).Google Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Richard B. Hornick
    • 1
  1. 1.Medical Education AdministrationOrlando Regional Medical CenterOrlandoUSA

Personalised recommendations