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February 1987

The Unusual Presentations of Tularemia: Bacteremia, Pneumonia, and Rhabdomyolysis

Arch Intern Med. 1987;147(2):214. doi:10.1001/archinte.1987.00370020034028

The clinical presentations of tularemia are diverse, and because of this fact tularemia is overlooked even in endemic regions. This is especially true when the major manifestations are pneumonic or typhoidal and when patients do not give a history of activities usually associated with the disease, such as hunting or extensive outdoor exposure. Accurate diagnosis of tularemia early in the course of illness is difficult because diagnostic titers of tularemia agglutinins in the serum may require up to ten days or more to develop. Therefore, the clinician often must treat empirically and obtain convalescent specimens to retrospectively establish the diagnosis. Obtaining cultures of ulcers, lymph nodes, or other tissue is not recommended since the microorganism is fastidious in its growth and is a potential hazard to laboratory personnel.

We have seen four patients during a 17-month period who have had Francisella tularensis isolated from blood, and in each case tularemia