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  • Highly infectious after aerosolization
  • Infectious dose can be as low as 10-15 organisms
  • Person-to-person transmission does not occur


  • Incubation period is 3-6 days (ranges 1-21 days)
  • Aerosolization would most likely result in typhoidal tularemia, with pneumonic involvement
  • Typhoidal tularemia is a nonspecific illness, with fever, headache, malaise and non-productive cough (mortality rates can be as high as 30-60%)
  • Diagnosis requires high index of suspicion given nonspecific presentation

Laboratory Diagnosis

  • Bacterial cultures should be handled in a Biosafety Level 3 facility; isolation of organism can otherwise put laboratory workers at risk
  • Organism is difficult to culture and grows poorly on standard media; cysteine-enriched media is required
  • Serology is most commonly used for diagnosis

Patient Isolation

Standard precautions. Respiratory isolation not required.


  • Streptomycin (7.5 mg/kg IM q 12 hours × 10-14 days) or gentamicin (3-5 mg/kg/day IV or IM qd in 3 divided doses × 10-14 days) are the preferred antibiotics
  • Tetracyclines are alternative choices, although they are bacteriostatic and associated with higher relapse rates and must be continued for at least 14 days


  • Antibiotic prophylaxis is most effective if begun within 24 hours after exposure to aerosol
  • Tetracyclines are recommended for 14 days

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