Tularemia in Minnesota: an emerging and underappreciated infection.

Tularemia is a rare but often serious infectious disease caused by Francisella tularensis, a bacterium with an extremely low infectious dose and the ability to cause illness through several routes including arthropod bites, contact with infected animals and exposure to contaminated water, food or soil. Tularemia is found throughout the northern hemisphere, and cases have occurred in all U.S. states except Hawaii. Thirteen cases have been reported to the Minnesota Department of Health since 1994, including 3 in 2016. This article presents the 2016 cases as well as data on all the reported cases. Clinicians should consider tularemia in patients with a compatible clinical illness and exposure history, particularly those who present with acute fever and regional lymphadenopathy. Treatment should be initiated early in highly suspect cases, without waiting for laboratory results.