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Tularemia: Clinical Manifestations

There are six types of tularemia and the clinical presentation depends upon the mode of transmission:
  1. Ulceroglandular is the most common presentation. There is a skin ulcer at the entry site and enlarged lymph glands in the armpit or groin.
  2. The glandular form is similar in presentation to ulceroglandular, but without the ulcer.
  3. Oculoglandular occurs when the organism enters the eye.
  4. Oropharyngeal tularemia occurs when eating or drinking contaminated food or water, including undercooked meat.
  5. Pneumonic is the most serious type and comes from breathing aerosols. Aerosols are produced when a sick, dying, or dead rabbit is mown over or care is not taken in skinning an infected rabbit. Lungs can also be infected when other forms are untreated and the bacteria spread hematogenously.
  6. The typhoidal form is seen in 10-15% of cases in association with pneumonia.
Symptoms develop rapidly within 3-5 days after inoculation. Fever, chills, headache, malaise, fatigue, and myalgias 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