Introduction:
Background. Tularemia is a zoonosis caused by intracellular Gram-negative bacterium Francisella tularensis. F. tularensis exists as multiple subspecies: type A – subspecies F. tularensis tularensis and type B – subspecies F. tularensis holarctica and F. tularensis mediasiatica. Additionally, there exists a related species, Francisella novicida. Subspecies F. tularensis tularensis, holarctica, and mediasiatica can all cause infection in humans, although only subspecies F. tularensis tularensis is lethal. F. novicida has been reported to cause infection only in immunocompromised individuals. Tularemia is also known as “rabbit fever”, “hunters’ disease”, “deerfly fever”, “tick fever”, “O’Hara’s Disease” and “Francis’ Disease”. Tularemia has recently become a significant re-emerging disease in the world because of the important role of bacteria in biological terrorism agents.

Objective:
In this study, we aimed to evaluate the epidemiological, host immunity and clinical features of tularemia. .

Current state of knowledge:
Tularemia is more common in some groups of people. Groups at risk include foresters, hunters, people in contact with meat, farmers and veterinarians. In humans, the clinical symptoms of tularemia may vary depending on the bacterium’s virulence, amount, mode of entry into the body, and the person’s immunity. F. tularensis can infect a host through multiple routes, including the intradermal and respiratory routes, ingestion of contaminated water or food, or aerosols and laboratory exposure. Infection typically produces a febrile illness, although specific pathology is highly dependent upon the route of infection. Tularemia can develop in different forms: ulceroglandular form, glandular form, oropharyngeal, oculoglandular and pneumonic form. Tularemia can be difficult to diagnose. Blood tests, classical microbiology and molecular techniques can help confirm the diagnosis. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin. Tularemia vaccines have been used to protect military and laboratory personnel at high risk for exposure, but they are not available for the general population.

Conclusions:
The actual frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures. The signaling mechanisms by which F. tularensis modulates the immune response remain poorly understood. The key to the development of such a vaccine will be research on the host response to F. tularensis type A. Using protective clothes and repellents, as well as avoiding contact with wild and dead animals, provide protection from the disease. Hygienic conditions for food and beverages are extremely important, especially in countries where the oropharyngeal form is more common.