National case definition: Tularemia

Date of last revision/review: May 2008

National notification

Only confirmed cases of disease should be notified.

Type of surveillance

Routine case-by-case notification to the federal level

Case classification

Confirmed case

Clinical illness (see Clinical evidence section) 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

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

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

ICD code(s)

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

Comments

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