Tularemia Differential Diagnoses

Updated: Jan 12, 2023
  • Author: Kerry O Cleveland, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Diagnostic Considerations

Failure to consider tularemia in the differential diagnoses may lead to death if the patient is not treated properly.

Ulceroglandular tularemia is more likely to be diagnosed correctly than the typhoidal form because of the typical presentation of the former.

The typhoidal form, which is more deadly, presents as a nonspecific febrile illness, with little to suggest tularemia in the absence of a carefully taken epidemiologic history. In patients with typhoidal tularemia, other potentially life-threatening infections should be considered and excluded or should be treated as appropriate. Supportive care with fluids and antipyretics may be indicated.

A Turkish study concluded that serologic tests should be used to differentiate between tuberculous cervical lymphadenitis (TCL) and oropharyngeal tularemia, both of which have similar clinical findings. In the study, Karabay et al obtained serum from 1170 persons who had been diagnosed with TCL and from 596 healthy controls. Examining titers of 1:80 or higher, the investigators found that serum from 79 (6.75%) of the patients diagnosed with TCL was positive for F tularensis antibodies, whereas serum from only two (0.34%) persons in the control group showed positive results. [62]

Other conditions to consider in the differential diagnosis of tularemia include the following:

  • Mumps

  • Mycoplasma infections

  • Parainfluenza virus infections

  • Bacterial pericarditis

  • Viral pericarditis

  • Pharyngitis

  • Plague

  • Pneumonia

  • Rhabdomyolysis

  • Rickettsial infection

  • Rocky Mountain spotted fever

  • Salmonella infection

  • Sporotrichosis

  • Syphilis

  • Toxoplasmosis

  • Tuberculosis

  • Catscratch disease

  • Plague

  • Lymphogranuloma venereum

  • Brucellosis

  • Influenza

  • Leishmaniasis

  • Anthrax

  • Disseminated mycobacterial disease

  • Disseminated fungal disease

  • Rat-bite fever

  • Nontuberculous mycobacterial infections

Differential Diagnoses

  • Chlamydial Infections

  • Diphtheria

  • Endocarditis, Bacterial

  • Endocarditis, Fungal

  • Legionella Infection

  • Lyme Disease

  • Malaria

  • Mononucleosis and Epstein-Barr Virus Infection

  • Psittacosis (Parrot Fever)

  • Q Fever