A Comprehensive Review of Diagnostic Techniques for Francisella tularensis: Challenges and Strategies

Tularemia, caused by Francisella tularensis, is a zoonotic disease with various sources, transmission routes, and geographically different clinical signs. Diagnosis is challenging due to nonspecific symptoms, highlighting the importance of laboratory testing for accurate detection, effective outbreak management, and targeted treatment. Recent improvements have enhanced the accuracy of sensitive and specific immunological and molecular methods. Techniques such as enzyme-linked immunosorbent assay, immunochromatography, microagglutination tests, indirect immunofluorescence assays, and PCR continue to be key detection tools. Molecular typing methods such as whole-genome sequencing, single-nucleotide polymorphism analysis, multiple-locus variable-number tandem repeat analysis, pulsed-field gel electrophoresis, and matrix-assisted laser desorption ionization-time of flight enable precise genetic characterization of F. tularensis strains. These methods improve understanding of phylogeny, strain diversity, and transmission routes, while supporting outbreak investigations. This review aims to provide a comprehensive overview of current laboratory methods for diagnosing and typing tularemia as well as their application in clinical and research settings.