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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.

CSTE Position Statement(s)

  • 09-ID-66

Clinical Description

An illness characterized by several distinct forms, including the following:

  • 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

Laboratory Criteria For Diagnosis


  • Elevated serum antibody titer(s) to Francisella tularensis antigen (without documented fourfold or greater change) in a patient with no history of tularemia vaccination, OR
  • Detection of F. tularensis in a clinical specimen by fluorescent assay


  • Isolation of F. tularensis in a clinical specimen, OR
  • Fourfold or greater change in serum antibody titer to F. tularensis antigen


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

Case Classification


A clinically compatible case with laboratory results indicative of presumptive infection


A clinically compatible case with confirmatory laboratory results


The 1996 case definition appearing on this page was re-published in the 1999 CSTE position statement 1999-ID-6 and the 2009 CSTE position statement 09-ID-66. Thus, the 1996, 1999, and 2010 versions of the case definition are identical.

Related Case Definition(s)