There are six types of tularemia, and the clinical presentation depends upon the mode of transmission:
- Ulceroglandular is the most common presentation. A skin ulcer at the entry site and enlarged lymph glands in the armpit or groin.
- The glandular form is similar in presentation to ulceroglandular but without the ulcer.
- Oculoglandular occurs when the organism enters the eye.
- Oropharyngeal tularemia occurs when eating or drinking contaminated food or water, including undercooked meat.
- Pneumonia is the most serious type and comes from breathing aerosols. Aerosols are produced when a sick, dying, or dead rabbit is blown over, or care is not taken to skin an infected rabbit. Lungs can also be infected when other forms are untreated, and the bacteria spread hematogenously.
- The typhoidal form is seen in 10–15% of cases associated with pneumonia.
Symptoms develop rapidly within 3–5 days after inoculation. Fever, chills, headache, malaise, fatigue, and myalgia are the most common symptoms. Cough is present in about one-third of patients. Sore throat, skin ulcers, pleural effusions, pneumonia, and acute respiratory distress syndrome may result. Nausea and vomiting also may occur.
General laboratory findings include:
- Leukocytosis
- Thrombocytopenia
- Elevated erythrocyte sedimentation rate (ESR)
- Elevated liver enzymes
- Sterile pyuria in 20–35% of patients
