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Case Definition

Confirmed Case

Clinical illness with laboratory confirmation of infection:

  • Isolation of Francisella tularensis in an appropriate clinical specimen OR
  • Fourfold or greater change in serum antibody titre to F. tularensis antigen OR
  • Detection of F. tularensis nucleic acid by polymerase chain reaction (PCR) or sequence-based analysis

Probable Case

Clinical illness with laboratory evidence:

  • Detection of F. tularensis in a clinical specimen by fluorescent assay OR
  • >1:128 microagglutination titre or >1:160 tube agglutination in a single serum specimen

Definition of clinical illness

Clinical illness is 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.
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.
SOURCE: Tularemia ( )
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