Tularemia

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Nationally notifiable since 2002

1.0 National Notification

Only confirmed cases of disease should be notified.

2.0 Type of Surveillance

Routine case-by-case notification to the federal level

3.0 Case Classification

3.1 Confirmed case

Clinical illness (see section 5.0) with laboratory confirmation of infection:

• isolation of Francisella tularensis from an appropriate clinical specimen
  OR
• a significant (e.g. fourfold or greater) change in serum antibody titre to F. tularensis antigen

3.2 Probable case

Clinical illness with laboratory evidence:

• detection of F. tularensis in a clinical specimen by fluorescent assay OR
• detection of F. tularensis nucleic acid
  OR
• ≥ 1:128 microagglutination titre or ≥ 1:160 tube agglutination in a single serum specimen

4.0 Laboratory Comments

5.0 Clinical Evidence

Clinical diagnosis is supported by evidence or history of a tick or deerfly bite, exposure to the tissues of a mammalian host of Francisella tularensis or exposure to potentially contaminated water.

Clinical illness is characterized by several distinct forms:

Ulceroglandular:

cutaneous ulcer with regional lymphadenopathy

Glandular:

regional lymphadenopathy with no ulcer; oculoglandular conjunctivitis with preauricular lymphadenopathy; oropharyngeal stomatitis or pharyngitis; or tonsillitis and cervical lymphadenopathy

Intestinal:

intestinal pain, vomiting, and diarrhea; pneumonic primary pleuropulmonary disease; typhoidal febrile illness without early localizing signs and symptoms

6.0 ICD Code(s)

6.1 ICD-10 Code(s)

A21

Tularaemia (includes: deer-fly fever, infection due to Francisella tularensis, rabbit fever)

A21.0

Ulceroglandular tularaemia

A21.1

Oculoglandular tularaemia (Ophthalmic tularaemia)

A21.2

Pulmonary tularaemia

A21.3

Gastrointestinal tularaemia (Abdominal tularaemia)

A21.7

Generalized tularaemia

A21.8

Other forms of tularaemia

A21.9

Tularaemia, unspecified

6.2 ICD-7 Code(s)

7.0 Type of International Reporting

8.0 Comments

Probable case definitions are provided as guidelines to assist with case finding and public health management, and are not for national notification purposes.

9.0 References

Date of Last Revision/Review:

May 2008