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Tularemia, a zoonosis caused by the gram-negative coccobacillus Francisella tularensis, is spread most often through direct contact with infected feral animals, arthropod bites, or ingestion or inhalation of contaminated material — but not from person to person. It manifests as an ulceroglandular, occuloglandular, intestinal, respiratory, or febrile typhoidal disease. The incubation period is typically 3 to 5 days but may be longer, and the overall case fatality rate varies by strain (from <2% to 24%).
During the first 9 months of 2015, 100 cases of tularemia were reported in Colorado (43), Nebraska (21), South Dakota (20), and Wyoming (16), representing an increase in annual cases ranging from 70% (Wyoming) to 975% (Colorado). Presentations…