A case of insect borne tularemia above the tree line

A case of insect borne transmission of ulceroglandular tularemia in Canada above the tree line is presented. It seems likely from the available entomological data that a mosquito was the vector in this case. Mosquito vectors may be important in inducing the high seroprevalence of antibodies to F. tularensis above the treeline. This case is presented to make clinicians aware of the possibility of tularemia in cases of insect borne ulceroglandular disease in the arctic and, the necessity of measuring tularemia agglutinins in these patients. It should be noted that isolation of this organism poses a risk to laboratory personnel, and therefore should only be attempted in a reference laboratory. Therefore the diagnosis is based upon the finding, in the appropriate clinical context, of a four-fold rise in the tularemia agglutinins, or a single convalescent titre of 1:160 or greater.