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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

Clinical Description

An illness characterized by several distinct forms, including:

  • Ulceroglandular: cutaneous ulcer with regional lymphadenopathy
  • Glandular: regional lymphadenopathy with no ulcer
  • Oculoglandular: conjunctivitis with preauricular lymphadenopathy
  • Intestinal: pharyngitis, intestinal pain, vomiting, and diarrhea
  • Pneumonic: primary pleuropulmonary disease
  • Typhoidal: febrile illness without early localizing signs and symptoms

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

Laboratory Criteria For Diagnosis

  • Isolation of F. tularensis from a clinical specimen, OR
  • Demonstration of F. tularensis in a clinical specimen by immunofluorescence, OR
  • Fourfold or greater rise in agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart, analyzed at the same time, and in the same laboratory

Case Classification


A clinically compatible case with supportive serologic results (tularemia agglutination titer of greater than or equal to 160 in one or more serum specimens obtained after onset of symptoms)


A case that is laboratory confirmed

Related Case Definition(s)