Man Diagnosed With Rare Rabbit Fever as Insect-Borne Illnesses Rise

Florida has reported its fifth case in 10 years of a rare tick-borne infection that can kill as many as one in 10 patients, prompting fresh concerns that the disease may be expanding its reach across the United States.

Doctors writing in a medical journal said an unidentified 36-year-old man was diagnosed with tularemia, an illness caused by the bacterium Francisella tularensis. The infection can lead to pneumonia and sepsis and is commonly called “rabbit fever” because the bacteria are often found in rabbits.

The diagnosis came only after the patient visited an emergency department roughly four times over an eight-month period.

For six months, he experienced fever, night sweats, chills and exhaustion. His condition later worsened, bringing debilitating fatigue that left him unable to get out of bed, along with occasional nosebleeds and blood in his urine.

Doctors initially could not determine what was causing the illness. The investigation shifted after the man disclosed that he had hunted deer and wild turkeys, leading physicians to order tests for tick-borne infections.

Around 200 tularemia cases are reported across the country each year, with nearly all occurring in the South-Central states, including Arkansas, Kansas, Missouri and Oklahoma.

However, health concerns have grown as the infection appears to be turning up in new locations. Three probable cases were reported in New York this year, followed by the newly identified case in Florida.

Rising temperatures and longer summers are helping ticks move into new areas of the country. Other tick-borne illnesses are spreading as well, including Lyme disease, which can produce the familiar “bullseye” rash around a bite.

In the American Journal of Case Reports, doctors from the Mayo Clinic’s center in Florida wrote: “With climate patterns changing, to which insect vectors are particularly sensitive, re-emergence of otherwise rare infectious disease pathogens can be seen and should be explored in otherwise difficult-to-diagnose cases.”

The 36-year-old man first sought emergency care after enduring six months of fever, night sweats, chills and fatigue. He had also lost 30 pounds without changing his diet or exercise routine.

Doctors were unable to identify the cause during his initial visit. Several weeks later, he returned after developing extreme fatigue that caused him to miss work twice a week.

He was sent for additional testing but declined. Three weeks later, he came back with a 103F fever, body aches, headaches, shortness of breath, prolonged daytime sleep and difficulty waking.

When a series of tests again produced negative results, the patient told doctors he had recently hunted deer and wild turkey and eaten the meat.

That information raised two possibilities: a foodborne infection linked to wild game and a tick-borne disease associated with spending time outdoors while hunting.

Doctors ordered a broader panel of tests, which ultimately confirmed tularemia.

People can contract tularemia through a tick bite or by eating undercooked meat from an infected animal. The bacterium typically infects rabbits, hares and rodents.

During further questioning, the man recalled being bitten by a tick roughly two to three months earlier. He said the meat he consumed had been thoroughly cooked.

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He had not traveled outside the United States recently, but he had visited Tennessee, another state where tularemia occurs.

The diagnosis was Florida’s fifth tularemia case in the past decade and the ninth reported in the state since 2005, the earliest year for which data are available.

Tularemia is caused by the bacterium Francisella tularensis.

Often, it infects people from tick and deer fly bites. It can also be spread by eating infected rabbits, hares or rodents, handling infected dead animals, drinking contaminated water or breathing in dust laced with the bacteria. 

Tularemia is treated with antibiotics if caught early. However, most people do not realize they have been exposed until symptoms appear.

Cases typically spike from May through September, peaking in June. But there are signs that it is becoming more common.

In 2023, there were 196 reported cases in the US, a 56 percent increase compared to a decade ago. 

First-line treatments now include ciprofloxacin, doxycycline, gentamicin and levofloxacin. 

However, without treatment, tularemia is fatal in about 10 percent of cases. But with prompt antibiotics, that drops to less than one percent.

Still, recovery can take weeks or even months.

Symptoms usually appear three to five days after exposure and come on suddenly. 

They can include high fever, chills, severe headache, muscle aches, joint stiffness and a skin sore or ulcer at the bite site. Swollen lymph nodes are also common.

In more severe cases, the infection can spread to the lungs, causing pneumonia and shortness of breath.

The man in Florida was given 750mg daily of the antibiotic levofloxacin for two weeks. His fevers stopped after about one week on the medication, and one month after treatment, he reported improvements in his appetite. 

He continued suffering from a lack of energy but did not have any additional episodes of extreme fatigue and was able to return to his regular activities. His doctors wrote that his symptoms should gradually improve over time.