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| Fig. 27.12 Tularemia. Patient with history of deerfly bite on thigh while fishing in New Mexico. The patient has an eschar at the bite site and a suppurative lymph node in the groin. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
Tularemia has six presentations: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic forms. The ulceroglandular form is the most common presentation and the one that typically demonstrates skin lesions. The primary skin lesion begins as a small papule at the inoculation site that rapidly necroses. The papule may be surrounded by an area of cellulitis and is characteristically associated with painful regional lymphadenopathy (Fig. 27-12). Systemic symptoms include fever, chills, headache, and malaise.
