Tularemia is a re-emerging bacterial disease that affects humans, wild animals, and domestic animals. The disease is caused by Francisella tularensis that is found all over the world, but it is most commonly reported in North America, a few Scandinavian and Asian countries. The disease can occur in sporadic and epidemic form. Humans acquire the infection through the handling or ingestion of infected animals, vector bites, interaction with the aquatic environment, and aerosol inhalation. The disease classically manifests by the ulceroglandular, glandular, oculoglandular, oropharyngeal, respiratory and typhoidal forms. A rapid onset of fever, chills, headaches, diarrhea, muscular aches, joint pain, dry cough, and increasing weakening are all common symptoms. Because of its low infectious dose, ability to survive in the environment, and ability to be easily disseminated by aerosol, Francisella tularensis has been designated as a "category A" agent of greatest concern for bioterrorism. Laboratory help that include microbiological, immunological and molecular techniques is needed to make an unequivocal diagnosis of disease. In untreated patients, the fatality may be high. Tularemia can be prevented by using insect repellent, wearing gloves when handling sick or dead animals, thoroughly cooking game meat before eating it and not drinking untreated water. Prophylactic treatment and health education of the high risk groups is imperative.
