Classification: ICD-9 021; ICD-10 A21
Syndromes and synonyms: Rabbit fever, deerfly fever, hare fever, lemming fever, Ohara fever, Francis disease.
Agent: Francisella tularensis tularensis (Type A), F. tularensis holarctica (Type B), F. tularensis mediasiatica, Gram-negative non-motile intracellular coccobacilli that infect macrophages. Type A is highly virulent and divided into two clades: A.I and A.II. F. tularensis is considered a potential biological warfare agent. F. novicida is rarely virulent.
Reservoir: Lagomorphs and rodents (ground squirrels) for F. tularensis (Types A and B) in North America. Aquatic rodents (beavers, muskrats) in North America, hares and small rodents in northern Eurasia, for F. holarctica (Type B). The bacterium can persist in water.
Vector: The primary vectors are ticks and biting flies (deer flies, tabanids). In central Europe: Dermacentor reticulatus and Ixodes ricinus are important vectors. In eastern USA, D. variabilis is the most important vector. In western USA, biting flies are the predominant vectors in arid regions. In Russia, transmission is both by ticks (Ixodes) and mosquitoes.
Transmission: By arthropod bite handling or processing of infected animal carcasses or tissues, by ingestion of contaminated water, soil or food, or by inhalation of contaminated dust or aerosols.
Cycle:
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