Tularemia is caused by the Gram-negative bacterial pathogen Francisella tularensis. Infection of macrophages and their subsequent death are believed to play important roles in the progression of disease. Because complement is a particularly effective opsonin for Francisella, we asked whether complement-dependent uptake of F. tularensis strain SCHU S4 affects the survival of primary human macrophages during infection. Complement component C3 was found to be an essential opsonin in human serum not only for greatly increased uptake of SCHU S4 but also for the induction of macrophage death. Single-cell analysis also revealed that macrophage death did not require a high intracellular bacterial burden. In the presence of C3, macrophage death was observed at 24 h postinfection in a quarter of the macrophages that contained only 1 to 5 bacterial cells. Macrophages infected in the absence of C3 rarely underwent cell death, even when they contained large numbers of bacteria. The need for C3, but not extensive replication of the pathogen, was confirmed by infections with SCHU S4 ΔpurMCD, a mutant capable of phagosome escape but of only limited cytosolic replication. C3-dependent Francisella uptake alone was insufficient to induce macrophage death, as evidenced by the failure of the phagosome escape-deficient mutant SCHU S4 ΔfevR to induce cell death despite opsonization with C3. Together, these findings indicate that recognition of C3-opsonized F. tularensis, but not extensive cytosolic replication, plays an important role in regulating macrophage viability during intracellular infections with type A F. tularensis. KEYWORDS C3, Francisella tularensis, cell death, complement, macrophage F rancisella tularensis is the causative agent of the zoonotic life-threatening disease tularemia. Among the subspecies responsible for disease in human beings, F. tularensis subsp. tularensis (type A) is the most virulent and causes high morbidity and mortality when delivered via the respiratory route (1-4). Very low minimum infectious doses have been reported with pulmonary challenge in humans (2, 5). In mice, alveolar macrophages are among the earliest cells infected following respiratory challenge (6-8). F. tularensis rapidly disrupts the phagosome and enters the cytosol of cultured macrophages, where it replicates to high intracellular numbers (9-11). Likewise, phagocytic cell death and bacteremia follow infection of mice with F. tularensis and lead to secondary colonization and pathology in the spleen, liver, and draining lymph nodes (12-15). Indeed, one of the hallmark histopathological features of disseminated tularemia caused by the F. tularensis subsp. tularensis is the appearance of infected clusters of macrophages and myeloid cells (microgranulomas), which rapidly transform into necrotic foci (13)(14)(15)(16). Infection of macrophages with the laboratory strain F. tularensis subsp. tularensis SCHU S4 does not appear to activate caspase-1-mediated pyroptosis (17, 18), as has been reported for Francisella novicida strain U...