Therapy is limited to supportive care. Recovered patients should not donate blood for at least 6 months. While tularemia can be contracted by handling tissues of infected animals, especially by hunters who skin wild rabbits, more than half of all cases result from tick bites. Approximately 150-300 cases are reported each year, mostly from Arkansas, Missouri, and Oklahoma. A sore or ulcer develops within 24-48 hours at the site of tick bite, usually on lower extremities or trunk.
Lymph glands become swollen and painful.
The disease may be mild and self-limited, with fever abating within 4 weeks. A more fulminant disease leads to fever with chills, headache, abdominal pain, and severe prostration. A serum agglutination test can detect antibodies 10-14 days after onset of illness. Titer peaks in 4-6 weeks. Tetracycline or chloramphenicol are alternatives, but relapses can occur if taken for less than 14 days.