A rare bacterial infection acquired from ticks or animals. It can cause fever, large swollen lymph nodes (“swollen glands”), bad sore throat, a skin ulcer, and more (and worse). We think of it in rural areas; states with the most cases are NB, MO, AR, OK, and KS. Big lymph nodes in the neck are the main clue.
If it spreads to the blood or lungs it’s often fatal. Diagnosis is difficult, because it’s impossible to culture the bacteria. Antibody blood tests don’t turn positive for 2 weeks, & false-positives can be due to old infections (which were silent). Common antibiotics may not work; patients may need special ones, sometimes IV.
If there’s more than one case of Tularemia at the same time, certainly if in an uncommon place for it, we worry about bioterrorism. Has never happened (yet).