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Tularemia

1. Disease Information / Identifiers

2026-06-22
Falcon MONDO:0018077 Model: Edison Scientific Literature 26 citations

1. Disease Information / Identifiers

Tularemia is a highly infectious zoonotic disease caused by the Gram-negative bacterium Francisella tularensis. It is recognized under multiple disease coding systems. While explicit codes from OMIM, Orphanet, MeSH, and MONDO were not directly recoverable in the available evidence, the ICD-10 code for tularemia is A21. Recognized synonyms include: tularemia, tularaemia, rabbit fever, deer fly fever, wild hare disease, Ohara’s disease, and water-rat trappers’ disease. Detailed mapping and methodology are maintained by Mondo and Orphanet for improved terminological interoperability, as summarized below:

Table (click to expand)
Resource Code Preferred label Synonyms URL/reference
OMIM Not established / no disease-specific OMIM code confidently confirmed from available context Tularemia Rabbit fever; deer fly fever; water-rat trappers’ disease; wild hare disease; Ohara’s disease (literature synonyms) (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2) OMIM is one of the external terminologies integrated by Mondo and mapped by Orphanet in general, but the tularemia-specific OMIM identifier was not recoverable from the available context excerpts without risking overstatement (vasilevsky2022mondounifyingdiseases pages 4-6, lucano2025theorphanetnomenclature pages 12-15, lucano2025theorphanetnomenclature pages 15-19). General OMIM: https://www.omim.org
Orphanet ORPHAcode present in Orphanet alignments, but tularemia-specific code not recoverable from available context excerpts Tularemia Rabbit fever; tularaemia/tularemia; deer fly fever; Ohara’s disease; wild hare disease; water-rat trappers’ disease (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2) Orphanet maintains rare-disease identifiers and maps them to ICD-10, ICD-11, OMIM, MeSH, and MONDO; infectious rare diseases are included in Orphanet’s scope in Europe (lucano2025theorphanetnomenclature pages 12-15, lucano2025theorphanetnomenclature pages 15-19, lucano2025theorphanetnomenclature pages 26-29). General Orphanet: http://www.orpha.net/
ICD-10 A21 Tularemia Rabbit fever; tularaemia/tularemia (literature/terminology consensus) (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2) Orphanet reports broad ICD-10 coverage and mapping procedures for rare diseases; tularemia is the standard ICD-10 entity A21. General ICD-10 reference framework discussed in Orphanet nomenclature papers (lucano2025theorphanetnomenclature pages 15-19, lucano2025theorphanetnomenclature pages 26-29). WHO ICD resources: https://icd.who.int
MeSH MeSH term exists for Tularemia, but exact descriptor ID not recoverable from available context excerpts Tularemia Rabbit fever; tularaemia/tularemia (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2) MeSH is explicitly listed by Orphanet as a mapped target terminology and cited by Mondo as a major disease vocabulary resource, but the tularemia-specific MeSH identifier was not present in the available excerpts (lucano2025theorphanetnomenclature pages 12-15, vasilevsky2022mondounifyingdiseases pages 11-12). General MeSH: https://www.ncbi.nlm.nih.gov/mesh
MONDO MONDO term exists in principle for infectious diseases including tularemia, but tularemia-specific MONDO ID not recoverable from available context excerpts Tularemia Rabbit fever; tularaemia/tularemia; deer fly fever; Ohara’s disease; wild hare disease; water-rat trappers’ disease (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2) Mondo integrates OMIM, ICD-10-CM, Orphanet, MeSH-linked sources, and infectious diseases with stable MONDO identifiers and scoped synonyms; however, the tularemia-specific MONDO accession was not contained in the available text snippets (vasilevsky2022mondounifyingdiseases pages 4-6, vasilevsky2022mondounifyingdiseases pages 6-11). General Mondo: https://mondo.monarchinitiative.org/

Table: This table summarizes Tularemia identifiers and preferred naming across major disease vocabularies using only information supportable from the available context. It is useful as a cautious crosswalk because it distinguishes confirmed terminology relationships from identifiers that were not directly recoverable in the provided source excerpts.

2. Etiology, Transmission, and Risk Factors

Tularemia is a zoonosis caused by F. tularensis, which infects a wide range of mammals (especially lagomorphs and rodents), birds, amphibians, invertebrates, and humans. The disease is re-emerging in many countries, and is recognized as a Category A biothreat agent due to its high infectivity and diverse transmission routes. Tularemia is primarily acquired via: - Direct contact with infected wild animals (especially rabbits, hares, voles, water voles). - Arthropod vectors: Predominantly ticks (Dermacentor, Ixodes) and mosquitoes in northern Europe and North America, with some regional specificity (e.g., Aedes cinereus in Sweden). - Ingestion of contaminated water, food, or contact with contaminated environments (aquatic/soil biofilms). - Inhalation of infectious aerosols or dust. Transmission is typically from the environment and animals—human-to-human transmission is not reported. F. tularensis is environmentally resilient, surviving for prolonged periods in water and soil. The most recent regional meta-analysis estimated human seroprevalence in the WHO Eastern Mediterranean region at 6.2% (95% CI: 4.2–9.2). Environmental prevalence (water/soil) was 5.8%; ticks showed 2.5% positivity, rodents 2.0%, and domestic ruminants 0.6% (sholeh2024epidemiologyoftularemia pages 1-2). Risk factors are predominantly environmental (outdoor activities, wildlife exposure) and occupational (e.g., farmers, hunters, laboratory workers). "Prophylactic measures must be adapted in each tularemia endemic area according to the predominant modes of human and animal infection. They require a One Health approach to control both animal and environmental reservoirs... as well as arthropod vectors, to slow the current expansion of endemic areas of this disease in a context of climate change" (maurin2024nonvaccinalprophylaxisof pages 1-2).

“Tularemia is a re-emerging zoonosis in many endemic countries. It is caused by Francisella tularensis, a gram-negative bacterium and biological threat agent.” Humans acquire infection “from the wild animal reservoir, the environmental reservoir or by the bite of arthropod vectors,” via “cutaneous, conjunctival, digestive or respiratory routes” (maurin2024nonvaccinalprophylaxisof pages 1-2).

Recent reviews agree that the causal agent is primarily F. tularensis subsp. tularensis (type A, more virulent, mainly North America) and subsp. holarctica (type B, widespread across Europe/Asia), while subsp. mediasiatica has not been isolated from human cases in the cited summaries (sholeh2024epidemiologyoftularemia pages 1-2, sharma2023tularemia–a pages 2-3).

Key transmission routes in current understanding are direct contact with infected animals, arthropod bites, inhalation of contaminated aerosols/dust, and ingestion of contaminated food or water. The 2024 EMRO meta-analysis states that F. tularensis is transferred to humans through “contact with infected wild animals,” “inhalation of infected aerosols,” “arthropod bites,” and “consumption of contaminated water or contaminated food” (sholeh2024epidemiologyoftularemia pages 1-2).

Important animal and vector risk factors include lagomorph and rodent exposure, especially rabbits, hares, voles, and water voles; ticks and mosquitoes are the dominant vectors in most endemic settings. The 2023 review notes that “ticks act as both reservoirs as well as vectors of infection since they can carry the bacteria by transstadial as well as transovarial transmission,” and that in Sweden and Finland “most of the cases of tularemia occur by the bite of mosquitoes” (sharma2023tularemia–a pages 2-3).

Environmental persistence is now emphasized as part of the zoonotic cycle: F. tularensis “can survive for prolonged periods in aquatic and soil environments,” and tularemia risk is shaped by wildlife reservoirs plus environmental reservoirs, not only animal contact alone (maurin2024nonvaccinalprophylaxisof pages 1-2).

Illustrative recent epidemiologic data from the 2024 WHO-EMRO systematic review/meta-analysis show measurable exposure across humans, vectors, reservoirs, and environment: human seroprevalence 6.2% (95% CI 4.2–9.2), high-risk individuals 6.92%, environmental samples 5.8% overall (9.4% by PCR; 0.5% by culture), ticks 2.5%, rodents 2.0%, and domestic ruminants 0.6% (sholeh2024epidemiologyoftularemia pages 1-2).

These data support a multi-compartment risk model: human risk rises where infected wildlife, vectors, and contaminated water/soil overlap. The same meta-analysis concludes that tularemia is “an endemic but neglected disease” in the WHO-EMRO region, underscoring under-recognition outside classic hotspots (sholeh2024epidemiologyoftularemia pages 1-2).

Geographic and ecological risk is heterogeneous. The 2023 review highlights that Europe has seen re-emergence, including “a four-fold increase in Switzerland and a 10-fold increase in Sweden in the last three decades,” with Scandinavia reporting particularly high annual case numbers; type A remains largely restricted to North America, whereas type B predominates in Europe and Asia (sharma2023tularemia–a pages 2-3).

Protective factors are mostly environmental and behavioral rather than genetic in the current literature excerpts: avoiding arthropod bites, limiting exposure to potentially infected wildlife/carcasses, reducing inhalation of contaminated dust during outdoor/agricultural activities, and preventing use of contaminated water sources are the main implied protective measures; no validated human protective genetic variants were identified in the available 2023–2024 context (sholeh2024epidemiologyoftularemia pages 1-2, maurin2024nonvaccinalprophylaxisof pages 1-2).

Expert opinion in 2024 strongly favors a One Health framework: “Prophylactic measures must be adapted in each tularemia endemic area according to the predominant modes of human and animal infection. They requires a One Health approach to control both animal and environmental reservoirs of F. tularensis, as well as arthropod vectors, to slow the current expansion of endemic areas of this disease in a context of climate change” (maurin2024nonvaccinalprophylaxisof pages 1-2).

Blockquote: This blockquote summarizes 2023-2024 evidence on tularemia causation, transmission routes, reservoir/vector ecology, risk factors, and prevention-relevant One Health insights. It includes direct quotes and recent pooled statistics useful for a disease knowledge base entry.

No validated human genetic risk or protective variants were reported in recent authoritative reviews (2023–2024). Protective factors are behavioral and environmental (preventing tick/mosquito bites, avoiding contact with wildlife, using safe water sources).

3. Phenotypes and Clinical Spectrum (Partial)

While a complete recent phenotypic breakdown could not be synthesized before the time expiration, tularemia displays a diverse clinical picture determined largely by the infection route: - Ulceroglandular form: most common, following arthropod bites or animal contact—characterized by skin ulcer at entry site with regional lymphadenopathy. - Glandular form: regional lymphadenopathy without skin ulceration. - Oculoglandular, oropharyngeal, pulmonary, and typhoidal forms: related to local entry and systemic involvement; severe cases may progress to pneumonia, sepsis, or typhoidal illness. - General symptoms: high fever, fatigue, malaise, and flu-like illness precede localized findings.

Complications can include pneumonia, sepsis, myocarditis, and chronic symptoms if untreated. No established HPO term mapping was extracted in this time-constrained run.

4. Genetic and Molecular Information

Tularemia is not a genetic or hereditary disease. There are no confirmed causal genes, chromosomal abnormalities, or pathogenic variants in humans. All cases are related to infection by F. tularensis (sharma2023tularemia–a pages 1-2, degabriel2023pathogenicityandvirulence pages 1-2, sholeh2024epidemiologyoftularemia pages 1-2).

5. Environmental Information

Tularemia is intimately linked to environmental exposures, with aquatic, soil, and animal reservoirs all contributing to persistence and outbreaks. The pathogen is resilient and adapts to biofilm and environmental niches, made more significant by climate and ecological changes (maurin2024nonvaccinalprophylaxisof pages 1-2).

References / URLs (Cited Contexts)

Further detailed clinical, diagnostic, prognostic, and treatment characteristics require continued evidence synthesis, as multiple high-value targets remain in the plan.

References

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  2. (degabriel2023pathogenicityandvirulence pages 1-2): Manon Degabriel, Stanimira Valeva, Sandrine Boisset, and Thomas Henry. Pathogenicity and virulence of francisella tularensis. Virulence, Nov 2023. URL: https://doi.org/10.1080/21505594.2023.2274638, doi:10.1080/21505594.2023.2274638. This article has 49 citations and is from a peer-reviewed journal.

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  5. (lucano2025theorphanetnomenclature pages 15-19): C. Lucano, D. Lagorce, A. Olry, H. Ali, V. Lanneau, M. De Carvalho, A. Dilsizoglu Senol, M. Fructuoso, E. Gaillard, M.-C. Gaillard, S. Mihic, M. Tannoury, F. Sauvage, C. Rodwell, S. Maiella, M. Hanauer, and A. Rath. The orphanet nomenclature of rare diseases: a standard terminology for improved patient recognition and data interoperability. MedRxiv, Aug 2025. URL: https://doi.org/10.1101/2025.08.10.25333394, doi:10.1101/2025.08.10.25333394. This article has 3 citations.

  6. (lucano2025theorphanetnomenclature pages 26-29): C. Lucano, D. Lagorce, A. Olry, H. Ali, V. Lanneau, M. De Carvalho, A. Dilsizoglu Senol, M. Fructuoso, E. Gaillard, M.-C. Gaillard, S. Mihic, M. Tannoury, F. Sauvage, C. Rodwell, S. Maiella, M. Hanauer, and A. Rath. The orphanet nomenclature of rare diseases: a standard terminology for improved patient recognition and data interoperability. MedRxiv, Aug 2025. URL: https://doi.org/10.1101/2025.08.10.25333394, doi:10.1101/2025.08.10.25333394. This article has 3 citations.

  7. (vasilevsky2022mondounifyingdiseases pages 11-12): Nicole A Vasilevsky, Nicolas A Matentzoglu, Sabrina Toro, Joseph E Flack, Harshad Hegde, Deepak R Unni, Gioconda F Alyea, Joanna S Amberger, Larry Babb, James P Balhoff, Taylor I Bingaman, Gully A Burns, Orion J Buske, Tiffany J Callahan, Leigh C Carmody, Paula Carrio Cordo, Lauren E Chan, George S Chang, Sean L Christiaens, Michel Dumontier, Laura E Failla, May J Flowers, H. Alpha Garrett, Jennifer L Goldstein, Dylan Gration, Tudor Groza, Marc Hanauer, Nomi L Harris, Jason A Hilton, Daniel S Himmelstein, Charles Tapley Hoyt, Megan S Kane, Sebastian Köhler, David Lagorce, Abbe Lai, Martin Larralde, Antonia Lock, Irene López Santiago, Donna R Maglott, Adriana J Malheiro, Birgit H M Meldal, Monica C Munoz-Torres, Tristan H Nelson, Frank W Nicholas, David Ochoa, Daniel P Olson, Tudor I Oprea, David Osumi-Sutherland, Helen Parkinson, Zoë May Pendlington, Ana Rath, Heidi L Rehm, Lyubov Remennik, Erin R Riggs, Paola Roncaglia, Justyne E Ross, Marion F Shadbolt, Kent A Shefchek, Morgan N Similuk, Nicholas Sioutos, Damian Smedley, Rachel Sparks, Ray Stefancsik, Ralf Stephan, Andrea L Storm, Doron Stupp, Gregory S Stupp, Jagadish Chandrabose Sundaramurthi, Imke Tammen, Darin Tay, Courtney L Thaxton, Eloise Valasek, Jordi Valls-Margarit, Alex H Wagner, Danielle Welter, Patricia L Whetzel, Lori L Whiteman, Valerie Wood, Colleen H Xu, Andreas Zankl, Xingmin Aaron Zhang, Christopher G Chute, Peter N Robinson, Christopher J Mungall, Ada Hamosh, and Melissa A Haendel. Mondo: unifying diseases for the world, by the world. MedRxiv, Apr 2022. URL: https://doi.org/10.1101/2022.04.13.22273750, doi:10.1101/2022.04.13.22273750. This article has 158 citations.

  8. (vasilevsky2022mondounifyingdiseases pages 6-11): Nicole A Vasilevsky, Nicolas A Matentzoglu, Sabrina Toro, Joseph E Flack, Harshad Hegde, Deepak R Unni, Gioconda F Alyea, Joanna S Amberger, Larry Babb, James P Balhoff, Taylor I Bingaman, Gully A Burns, Orion J Buske, Tiffany J Callahan, Leigh C Carmody, Paula Carrio Cordo, Lauren E Chan, George S Chang, Sean L Christiaens, Michel Dumontier, Laura E Failla, May J Flowers, H. Alpha Garrett, Jennifer L Goldstein, Dylan Gration, Tudor Groza, Marc Hanauer, Nomi L Harris, Jason A Hilton, Daniel S Himmelstein, Charles Tapley Hoyt, Megan S Kane, Sebastian Köhler, David Lagorce, Abbe Lai, Martin Larralde, Antonia Lock, Irene López Santiago, Donna R Maglott, Adriana J Malheiro, Birgit H M Meldal, Monica C Munoz-Torres, Tristan H Nelson, Frank W Nicholas, David Ochoa, Daniel P Olson, Tudor I Oprea, David Osumi-Sutherland, Helen Parkinson, Zoë May Pendlington, Ana Rath, Heidi L Rehm, Lyubov Remennik, Erin R Riggs, Paola Roncaglia, Justyne E Ross, Marion F Shadbolt, Kent A Shefchek, Morgan N Similuk, Nicholas Sioutos, Damian Smedley, Rachel Sparks, Ray Stefancsik, Ralf Stephan, Andrea L Storm, Doron Stupp, Gregory S Stupp, Jagadish Chandrabose Sundaramurthi, Imke Tammen, Darin Tay, Courtney L Thaxton, Eloise Valasek, Jordi Valls-Margarit, Alex H Wagner, Danielle Welter, Patricia L Whetzel, Lori L Whiteman, Valerie Wood, Colleen H Xu, Andreas Zankl, Xingmin Aaron Zhang, Christopher G Chute, Peter N Robinson, Christopher J Mungall, Ada Hamosh, and Melissa A Haendel. Mondo: unifying diseases for the world, by the world. MedRxiv, Apr 2022. URL: https://doi.org/10.1101/2022.04.13.22273750, doi:10.1101/2022.04.13.22273750. This article has 158 citations.

  9. (sholeh2024epidemiologyoftularemia pages 1-2): Mohammad Sholeh, Safoura Moradkasani, and Saber Esmaeili. Epidemiology of tularemia in the countries of the who eastern mediterranean region (emro): a systematic review and meta-analysis. PLOS Neglected Tropical Diseases, 18:e0012141, May 2024. URL: https://doi.org/10.1371/journal.pntd.0012141, doi:10.1371/journal.pntd.0012141. This article has 11 citations and is from a domain leading peer-reviewed journal.

  10. (maurin2024nonvaccinalprophylaxisof pages 1-2): Max Maurin, Aurélie Hennebique, Camille Brunet, Léa Pondérand, Isabelle Pelloux, Sandrine Boisset, and Yvan Caspar. Non-vaccinal prophylaxis of tularemia. Frontiers in Microbiology, Nov 2024. URL: https://doi.org/10.3389/fmicb.2024.1507469, doi:10.3389/fmicb.2024.1507469. This article has 2 citations and is from a peer-reviewed journal.

  11. (sharma2023tularemia–a pages 2-3): Rinku Sharma, Rajendra Damu Patil, Birbal Singh, Sandip Chakraborty, Deepak Chandran, Kuldeep Dhama, Devi Gopinath, Gauri Jairath, Ajayta Rialch, Gorakh Mal, Putan Singh, Wanpen Chaicumpa, and G. Saikumar. Tularemia – a re-emerging disease with growing concern. Veterinary Quarterly, 43:1-16, Nov 2023. URL: https://doi.org/10.1080/01652176.2023.2277753, doi:10.1080/01652176.2023.2277753. This article has 48 citations and is from a domain leading peer-reviewed journal.

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