<P> Prevention is by using insect repellent, wearing long pants, rapidly removing ticks, and not disturbing dead animals . Treatment is typically with the antibiotic streptomycin . Gentamicin, doxycycline, or ciprofloxacin may also be used . </P> <P> Between the 1970s and 2015, around 200 cases are reported in the United States a year . Males are affected more often than females . It occurs most frequently in the young and the middle aged . In the United States, most cases occur in the summer . The disease is named after Tulare County, California, where the disease was discovered in 1911 . A number of other animals, such as rabbits, may also be infected . </P> <P> Depending on the site of infection, tularemia has six characteristic clinical variants: ulceroglandular (the most common type representing 75% of all forms), glandular, oropharyngeal, pneumonic, oculoglandular, and typhoidal . </P> <P> The incubation period for tularemia is one to 14 days; most human infections become apparent after three to five days . In most susceptible mammals, the clinical signs include fever, lethargy, loss of appetite, signs of sepsis, and possibly death . Nonhuman mammals rarely develop the skin lesions seen in people . Subclinical infections are common, and animals often develop specific antibodies to the organism . Fever is moderate or very high, and tularemia bacilli can be isolated from blood cultures at this stage . The face and eyes redden and become inflamed . Inflammation spreads to the lymph nodes, which enlarge and may suppurate (mimicking bubonic plague). Lymph node involvement is accompanied by a high fever . </P>

The most common clinical presentation of natural tularemia infection is