Indications for Testing
A history of contact with rabbits, ticks, dogs, cats, or skunks along with nonspecific febrile illness with prominent lymphadenopathy
- Negative history of animal contact does not rule out diagnosis
Laboratory Testing
- CDC diagnostic testing for tularemia
- Serology – acute and convalescent phase titers
- Preferred means of confirmation; retrospective in nature
- Fourfold increase between acute and convalescent serology or >1:160 on acute titer
- Cross-reactivity between Brucella, Salmonella, Yersinia, and Legionella antigens
- Culture – frequently negative
- Difficult to culture – fastidious organism
- Select agents – confirmed positive culture requires approval before transfer
- PCR – not widely available but very sensitive
- Consider testing for other disorders such as Rickettsia rickettsii (Rocky Mountain spotted fever), Rickettsia typhi (typhus fever), Brucella spp, and Pasteurella multocida (pasteurellosis)
Imaging Studies
Chest x-ray for patients presenting with signs and symptoms of pneumonia – demonstrates infiltrates
Differential Diagnosis