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Tularemia: An Infection Caused by Insects

Sometimes called rabbit fever, tularemia is caused by the Francisella tularensis bacteria. It is spread to humans through the bites of infected insects—most often, ticks, mosquitoes, and deerflies. It can also be passed to people by direct contact with infected animals, including rabbits, cats, hares, and muskrats. Your child can get tularemia by consuming contaminated food or water, eating inadequately cooked meat, or breathing in the bacteria. It cannot be transmitted from person to person.

Symptoms generally begin after an incubation period of usually 3 to 5 days, but possibly as long as 21 days.

According to the Centers for Disease Control and Prevention, there are about 200 human cases of tularemia reported per year in the United States, mostly in rural regions. Most cases occur during the summer months, similar to tick season.

Signs and Symptoms

Tularemia can cause illnesses that vary depending on how the infection was spread. Most commonly, a painful ulcer develops in the skin at the site of the insect bite, with tender enlarged lymph glands in the groin or armpits. Sometimes the glands may enlarge with no apparent bite.

Infection from food or water begins in the mouth with a severe sore throat, mouth sores, and enlargement of the neck lymph glands. With this form of the illness, your child may develop vomiting, diarrhea, and abdominal pain.

Illness from inhalation of the bacteria mainly results in fever, chills, muscle aches, and a dry cough. When the infection enters through the eyes, it results in swollen and red eyes with tender lymph glands in front of the ears. In many cases, tularemia is seen as a combination of several of these symptoms.

When to Call Your Pediatrician

Call your pediatrician immediately if your child develops an illness that could be a sign of tularemia, especially if he has a high fever, chills, a skin ulcer, or enlarged lymph glands. Prompt treatment is very important with this infection.

How Is the Diagnosis Made?

Your pediatrician will take samples of your child’s blood and have them tested in the laboratory for antibodies to tularemia. Sometimes the bacteria can be grown from the blood or infected sites.


The doctor will treat your child with an antibiotic such as streptomycin or gentamicin. Treatment usually lasts for a 10-day period, although sometimes longer for more serious cases. Early treatment of the infection is important.

What Is the Prognosis?

When children are treated with the appropriate antibiotics, their infection will quickly clear up, although relapses occasionally occur. If the infection goes completely untreated, however, it can be life threatening in some cases.


You can protect your child from the bites that cause tularemia by making sure he wears protective clothing.  Also, inspect your child frequently for ticks and remove any that may have attached themselves to his skin or scalp. The use of insect repellents, particularly those that contain the chemical DEET, is also recommended. Use gloves, masks, and goggles when skinning or dressing wild animals.

Other preventive measures include:

  • Instruct your child not to handle sick or dead animals.
  • Make sure all meat is cooked thoroughly before feeding it to your youngster.
  • Ensure that drinking water comes from an uncontaminated source.

A vaccine is not available to protect against tularemia, although interest in vaccine development has been growing since concerns have been raised about the use of the F tularensis bacteria as a bioterrorist weapon. This organism could be spread through an airborne route, at which point it could be breathed in and would need to be treated quickly with antibiotics.

Last Updated
Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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