What Is Tularemia?

Written by Kristen Fischer
Medically Reviewed by Shruthi N, MD on May 28, 2025
6 min read

Tularemiais a rare infectious disease that can be transmitted from soil and animals to people and other animals. It can usually be treated with antibiotics, but some cases can be serious. Learn more about this infection and how to protect yourself.

Tularemia is also called rabbit fever or deer fly fever. The infection is caused by a bacteria called Francisella tularensis. 

Tularemia occurs all over the world, but it’s most common in rural areas. The bacteria can survive in soil, water, and dead animals for weeks. That’s why it can cause infections in so many different ways. For example, you can get it from an insect bite or eating undercooked meat.

The CDC reported that from 2011 to 2022, there were 2,462 cases of tularemia across 47 states in the U.S. This was up 56% from the previous period, which ran from 2001 to 2010. The incidence of tularemia was highest in children aged 5-9 years, older men, and American Indian or Alaska Natives (AI/AN).

Cases of tularemia are becoming more common in the U.S., says Alison Hinckley, PhD, the epidemiology and surveillance team lead for the Bacterial Diseases Branch of the CDC’s Division of Vector-Borne Diseases.

“The causes for the increase in reported cases are not clear and probably reflect several factors, including more people being infected and better methods for detecting cases,” Hinckley says.

Of those cases, half came from four states: Arkansas, Kansas, Missouri, and Oklahoma. Among people in that dataset, 78% started experiencing symptoms between May and September.

People can become sick with tularemia, but it’s not a disease that naturally occurs in humans. It often affects rabbits and other animals, including rodents, sheep, and birds. House pets, such as dogs and cats, can get tularemia too. They can transmit it to other animals and humans.

How does it spread?

These are some of the ways people can get tularemia:

  • Insect bites, especially from a deer fly or tick
  • Coming into contact with the skin, hair, or meat of an animal that’s infected
  • Consuming contaminated water or food, such as undercooked meat
  • Inhaling bacteria that come up from the soil during activities such as construction or gardening

You can also become infected if you’re exposed to the bacteria in a laboratory setting, or in rare cases, as a result of bioterrorism.

The way you become infected can affect the type and severity of symptoms you’ll have. But just because you’re exposed to the bacteria doesn’t mean you’ll become sick with the disease.

If you do become sick after being exposed to Francisella tularensis, you’re likely to start having symptoms within three to five days, but it can take up to 2 weeks. 

There are different types of tularemia, each with its own specific symptoms. “The signs and symptoms of tularemia vary depending on how the bacteria enter the body,” Hinckley explains.

Ulceroglandular tularemia is the most common type of the disease. Symptoms can include:

  • An ulcer on the skin that’s usually caused by a bite from an infected animal or insect
  • Lymph glands that are painful and swollen
  • Fever
  • Chills
  • Headache
  • Fatigue

Oculoglandular tularemia affects the eyes. Symptoms can include:

  • Eye p ain, swelling, or discharge
  • Redness in the eye
  • Light sensitivity
  • An ulcer that forms inside the eyelid
  • Tender lymph glands around the ear, neck, and jaw

Oropharyngeal tularemia affects the mouth, throat, and digestive system. It’s the form of the disease that’s most often caused by eating undercooked meat from a wild animal or drinking contaminated water. Symptoms can include:

Pneumonic tularemia can cause symptoms that are often associated with pneumonia, including:

Typhoidal tularemia is a rare but very serious form of the disease. Symptoms can include:

Tularemia is rare, but some people may be at a higher risk compared with others. There are less than 300 cases reported each year in the U.S.

People get it most from tick bites or contact with a contaminated animal.

You are at higher risk for tularemia if you:

  • Work as a lab worker, farmer, veterinarian, landscaper, wildlife manager, and meat handler
  • Live in or visit the South Central U.S., especially Arkansas, Oklahoma, Missouri, Nebraska, South Dakota, and Kansas
  • Handle uncooked meat
  • Are outdoors near insects that bite
  • Have a weakened immune system 
  • Engage in landscaping, hunting, and gardening (Wild animals can be infected with tularemia, and moving soil may release bacteria.)

“Tularemia can be difficult to diagnose. It is a rare disease and the symptoms can be mistaken for other, more common illnesses,” Hinckley says.

Your doctor may conduct a variety of tests to confirm the presence of bacteria.

Tests to diagnose tularemia include:

  • Blood tests. A test may be normal at first because F. tularensis takes time to grow. More blood tests may be needed.
  • Biopsy. If you have large lymph nodes or ulcers, your provider may take a sample of your tissue for biopsy and see if F. tularensis is in your body.
  • Nasal or throat swab. Your provider may use a long stick with a soft tip (swab) to test for the bacteria. They will insert the stick and swab into your nose or throat to collect a sample. 
  • Pleural fluid test (thoracentesis). If you have fluid around your lungs, a provider may take a sample of it with a needle during a process called thoracentesis. A lab will test the sample for F. tularensis or see if it grows from the sample.
  • Chest X-ray. Your doctor may also order a chest X-ray to check for the signs of pneumonia.

 

Treatment usually involves antibiotics, either injected into your body or taken by mouth. Antibiotics such as azithromycin, ciprofloxacin, doxycycline, gentamicin, levofloxacin, and streptomycin can be used to treat the infection. Tularemia is curable. 

If you have complications such as pneumonia or meningitis, you’ll also need treatment for these conditions.

Some people use over-the-counter medications and home remedies to manage other symptoms associated with tularemia.

Usually, people who have had tularemia become immune to it, but some people may get it more than once.

You can protect yourself from tularemia by:

  • Not touching wild animals with your bare hands
  • Avoiding sick or dead animals
  • Wearing clothing that covers exposed skin (tight at the wrists and ankles)
  • Using insect repellents
  • Treating animals with tick repellent
  • Removing ticks from animals promptly
  • Watching your pets when they go outdoors
  • Drinking clean water
  • Fully cooking wild meats
  • Asking your doctor about starting medication if you think you’ve been exposed

Tularemia is a rare bacterial infection that occurs naturally in animals but can also affect humans. 

It most often occurs in animals such as rabbits, squirrels, and rodents. Ticks and flies can also spread it to humans and other animals. 

If you believe you may have tularemia, seek treatment immediately.

Can tularemia be fatal?

Yes, but it’s rare to die from it. Prompt treatment can give you the best outcome. Less than 1% of cases of tularemia are fatal when people treat the infection quickly with antibiotics.

How long after exposure does it take for symptoms to show up?

It takes three to five days for symptoms to show up, though some people don’t experience symptoms for up to two weeks of exposure to the bacteria.

Is tularemia a tick-borne disease?

Yes. It lives in animals but can also be in ticks. It can infect people who are bitten by an insect.

Can I catch tularemia from my dog?

Yes. Your dog can give it to you via its saliva if it has been near a rabbit or other animal with the infection. Dogs can get it the same way people do.