Francisella tularensis – Confirmation

Consistent with O. Reg. 671/92 of the French Language Services Act, laboratory testing information on this page is only available in English because it is scientific or technical in nature and is for use only by qualified health care providers and not by members of the public.

Background
This page provides details on the identification of Francisella tularensis at Public Health Ontario (PHO). Francisella tularensis is a highly infectious bacterium that causes tularemia, a serious zoonotic disease primarily affecting small mammals and humans. People can become infected in several different ways, including tick and deer fly bites, and contact with infected animals (especially rodents, rabbits, and hares).

For information regarding other testing options, refer to the following PHO webpages:

Aerobic bacteria identification : Bacterial cultures – Aerobic – Reference ID/Confirmation
Anaerobic bacteria identification: Bacterial cultures – Anaerobic – Reference Identification/Confirmation
Aerobic bacteria susceptibility testing: Antimicrobial Susceptibility Testing – Aerobic Bacteria
Anaerobic bacteria susceptibility testing: Antimicrobial Susceptibility Testing – Anaerobes

Updates

The turnaround time for Francisella tularensis confirmatory testing has been updated to reflect the National Microbiology Laboratory’s (NML) published turnaround time.
A table of possible results and corresponding interpretation has been added.

*Uncontrolled print copy. Valid only on day of print: 09 Oct 2025.

Testing Indications

Submitting laboratories must contact Public Health Ontario Laboratory Customer Service Centre at 416-235-6556 or 1-877-604-4567 prior to submission of the isolate.

Submit the isolate if:

Francisella tularensis is suspected based on colony morphology, Gram stain, catalase/oxidase reactions or other preliminary findings.
A patient presents with symptoms consistent with tularemia (e.g. ulceroglandular disease, respiratory illness) and has relevant exposure history (e.g. ticks, wild animals, contaminated water).¹

Acceptance/Rejection Criteria

Acceptable specimens include:

Pure cultures only: Mixed cultures or primary specimens are rejected
Properly labeled cultures: The patient and specimen identification on the requisition form must match the label information on the culture container
Source of isolation indicated: The requisition must clearly state the specimen source from which the isolate was recovered e.g. blood, bone marrow, CSF, joint fluid, abscess material etc.

Rejected specimens include:

Swabs: Specimens received dry or gel-based swabs will be rejected.
Primary specimens: Direct human and animal samples will be rejected.
Missing source information: Cultures without a clearly indicated source of the isolate on the requisition will be rejected.
Mixed or non-viable cultures
Mislabelled or unlabelled cultures

Specimen Collection and Handling

Specimen Requirements

Test Requested	Required Requisition(s)	Specimen Type	Minimum Volume	Collection Kit
Francisella tularensis – Confirmation	Reference Bacteriology Requisition	Pure viable subculture of organism on appropriate media that supports the growth	N/A	Agar plate or slant tube

Submission and Collection Notes

Complete all fields of the requisition form, including:

Test(s) Requested: Select confirmation and identification
Culture Information: Indicate the presumptive identification (if available) and Gram morphology; provide oxygen requirement for growth; oxidase test result; catalase test result; indicate of presence or absence of growth on MacConkey
Clinical diagnosis: Indicate if patient is immunocompromised
Date of Collection of primary specimen from which isolate was recovered
Source of isolate (Mandatory):
- The number of consecutive blood cultures positive for the submitted isolate when isolates are from blood cultures
- Type of urine specimen(s) (e.g. midstream, indwelling catheter, cystoscopy etc.)
- The site and type of wound swab; be as specific as possible (e.g. animal bite, surgical wound, decubitus ulcer, etc.
- If the source was collected for surveillance or screening, write the source or body part
- The type of specimen if other than blood culture, urine or wound swab, please provide as much detail as possible

Label the culture container(s) with the patient’s first and last name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. For additional information see: Criteria for Acceptance of Patient Specimens. Failure to provide this information may result in rejection or testing delay.

If susceptibility testing is required, the submitter must call within 5 days of receiving final results and provide necessary information and justification for susceptibility testing request.

Do not submit multiple isolates from the same specimen or site of infection.

Primary specimens are unacceptable as they must be processed at the originating laboratory.

If full bacterial identification and susceptibility testing is clinically indicated-such as in cases involving immunocompromised patients, it must be clearly indicated on the requisition.

Limitations

Culture must be viable. Use a fresh subculture and ship in conditions to ensure viability on receipt.

Storage and Transport

Place the sealed culture in a biohazard bag and properly seal. Store at 2-8°C while awaiting shipment. The requisition form must be placed in the outer pouch of the biohazard bag, separate from the culture container. Transport a fresh subculture to ensure viability on receipt. It should be shipped to PHO within 48 hours of isolation. All cultures must be shipped in accordance to the Transportation of Dangerous Good Act.

Special Instructions

Francisella tularensis must be handled in accordance with the Canadian Biosafety Standards and shipped in accordance with the Transportation of Dangerous Goods Regulations.

Requisitions and Kit Ordering

Test Frequency and Turnaround Time (TAT)

Daily testing (Monday to Friday) is conducted at PHO, Toronto location. Test results are typically available within 3 days of receipt by PHO.

Isolates that test positive for Fracisella tularensis at PHO are forwarded to the National Microbiology Laboratory (NML) for further confirmatory testing. The turnaround time for results from NML is typically between 4 to 14 calendar days from the date of receipt.

STAT and Critical Samples Testing

Urgent testing is available upon request by calling the Customer Service Centre 416-235-6556 or 1-877-604-4567.

Test Methods

Francisella tularensis identification at PHO is confirmed using the Canadian Laboratory Response Network (CLRN) real-time polymerase chain reaction assay.

Algorithm

Any isolate that is positive by the CLRN real-time PCR assay is considered as presumptive Francisella tularensis and is forwarded to the National Microbiology Laboratory (NML) for further confirmatory testing.

Interpretation

All results should be interpreted in the context of the specific clinical scenario. Given the overlap in the distribution of disease, testing for other potential co-pathogens should be considered.

Result	Interpretation
Not Detected	Francisella tularensis DNA NOT detected by real-time PCR
Presumptive Detected	Presumptive Francisella tularensis DNA DETECTED by Real-time PCR.
Inconclusive	Francisella tularensis real-time PCR result is inconclusive due to specimen quality. Please collect additional specimens for retesting.
Invalid	Francisella tularensis real-time PCR result is invalid. Sample is unsuitable for PCR testing.

Reporting

Results are reported to the physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.

Positive specimens for Francisella tularensis are reported to the Medical Officer of Health as per the Ontario Health Protection and Promotion Act.

References

Ministry of Health. Ontario Public Health Standards: Requirements for Programs, Services and Accountability. Infectious Disease Protocol- Appendix 1: Case Definitions and Disease Specific Information-Tularemia. May 2023. Available from: https://www.ontario.ca/page/ontario-public-health-standards-requirements-programs-services-and-accountability [Accessed 16 September 2025]