DOI: 10.1093/cid/ciad688 ISSN: 1058-4838

Francisella tularensis Bone and Joint Infections: United States, 2004–2023

Amy M Beeson, Molly Baker, BreeAnna Dell, Hannah Schnitzler, Hanna N Oltean, Tracy Woodall, Francis Riedo, Amy Schwartz, Jeannine Petersen, Alison F Hinckley, Grace E Marx
  • Infectious Diseases
  • Microbiology (medical)


Tularemia is caused by the highly infectious bacterium Francisella tularensis, which is recognized as a Tier 1 bioterrorism agent. Tularemia has a range of recognized clinical manifestations, but fewer than 20 bone or joint infections from 6 countries have been reported in the literature to date. This series includes 13 cases of F. tularensis septic arthritis or osteomyelitis in the United States during 2004–2023 and describes exposures, clinical presentation, diagnosis, and outcomes for this rare but severe form of tularemia. Clinicians should consider F. tularensis in patients with compatible exposures or a history of joint replacement or immunosuppression.

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