Putting tularemia on your radar

Another reason to be cautious about ticks.

These black-legged ticks, Ixodes scapularis, are found on a wide range of hosts including mammals, birds and reptiles. —Jim Gathany/Wikimedia Commons

When people think of tick-borne illnesses, they most often think of Lyme disease, but there are other possibilities as well. While nowhere near as common as Lyme disease, tularemia is something that Islanders should be aware of.

Tularemia comes from the bacterium Francisella tularensis, which is found in animals. “It’s a bacteria found primarily in ticks, rabbits, squirrels, and livestock,” Dr. Alam Virk, director of the Emergency Department at Martha’s Vineyard Hospital, said. The two most common ways of getting tularemia are by being bitten by an infected tick or breathing in the bacteria. 

If you mow over a rabbit’s nest, or rabbit droppings, it can be aerosolized,” Merrie Beth Dodge, D.O., hospitalist at MVH, said, “and you can breathe it in.”

“There are six different forms of tularemia,” Dr. Dodge said, “but only two that are primarily seen on the Island: ulceroglandular tularemia and pneumonic tularemia, which is the more commonly found.” 

Pneumonic tularemia is the most serious form. According to the CDC, this most often results from breathing dusts or aerosols containing the organism. The symptoms are often the symptoms typical of pneumonia: dry cough, chest pain, and difficulty breathing. 

Ulceroglandular tularemia usually occurs following a tick or deer fly bite, or after handling an infected animal. The symptoms for ulceroglandular tularemia include a skin ulcer that forms at the site of the infection, swollen and painful lymph glands, fever, chills, and headache. 

“Just to put things in perspective,” Dr. Dodge said, “throughout the summer we normally only see one or two cases, although in just the last two weeks in June this year we had already seen three cases.” In 2000, there was an outbreak of tularemia on the Island — 15 people contracted it.

Landscapers and farmers are clearly professionals who are at a higher risk for contracting tularemia, and to guard against inhaling the dust that can transmit tularemia, it’s essential that masks are used.

If you suspect that you have tularemia, consult your doctor at the first sign of illness. And be sure to tell your physician if you’ve been mowing. Tularemia should be taken very seriously; if not treated, it can be fatal. In 2018 a man contracted tularemia on the Island while clearing brush, and did not survive. However, this is very rare. “Tularemia is 100 percent curable if caught early on,” Dr. Virk said. “It can also be eliminated by wearing a N-95 mask, which is widely available at hardware stores and online.” 

Tularemia can usually be treated effectively if diagnosed early, with antibiotics such as streptomycin. Blood tests and cultures can help confirm the diagnosis. Treatment usually lasts 10 to 21 days, depending on the stage of illness and the medication used. 

But the best cure is prevention, so wear a mask when mowing, and don’t handle dead animals, especially rabbits, without wearing gloves, and wash your hands thoroughly. 


  1. I’m glad to see the article quotes Merrie Beth Dodge with respect to the aerosolized rabbit droppings. This stuff is all over and you need to wear a mask. The Mass Dept of Health has previously warned against running over a dead rabbit with your lawn mower being the only way to get pneumonic tularemia.

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