Tularemia

An acute febrile illness becomes suspicious for tularemia when it follows a compatible outdoor, animal, arthropod, aerosol, food, or water exposure and includes regional lymphadenopathy, a skin ulcer, conjunctivitis, pharyngitis, pneumonia, gastrointestinal symptoms, or unexplained systemic illness. The route of exposure often predicts the clinical form, but it does not exclude other forms. For the RN, the high-consequence decisions are practical: recognize the exposure pattern, assess whether the illness is severe, alert the laboratory before specimens are sent, administer the prescribed antimicrobial safely, and identify deterioration early. A negative antibody test during the first part of the illness does not reliably rule tularemia out.