Rabbits are considered to be the classic vectors of tularemia. A history of rabbit hunting, skinning, or preparation is appropriately sought in any patient who has a febrile illness with tender lymphadenopathy, often in the region of a draining skin ulcer. However, the frequent role of other vectors, particularly ticks, is often overlooked; a history of tick exposure may be most helpful in the prompt initiation of appropriate therapy. We describe a patient whose case exemplifies the relatively uncommon oculoglandular presentation of tularemia. Her graphic history of tick exposure, which typifies the summer association of ticks with this disease, prompted the following review of the seasonal experience with tularemia and its vectors in Virginia over the last 13 years.
A 67-year-old retired teacher from rural Virginia was admitted to the University of Virginia Hospital on June 18, 1974, because of progressive conjunctivitis in her left eye. Ten days previously