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Symptoms of tularemia
Last reviewed: 06.07.2025
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The bubonic form of tularemia occurs when the pathogen penetrates through the skin. It is characterized by swelling of the lymph nodes near the gate of infection. Most often, one, less often several lymph nodes are enlarged. The buboes are moderately painful, with clear contours, the size of a chicken egg. Subsequently, the buboes can slowly resolve, but often in the 3rd-4th week from the moment of appearance they soften, fester, the skin above them becomes edematous and hyperemic. The bubo opens with the release of creamy pus. A fistula is formed with subsequent scarring and sclerosis.
Ulcerative-bubonic form of tularemia usually occurs with bites from infected ticks, horseflies, mosquitoes, etc. At the site of the bite, after 1-2 days, a spot forms, then a papule, vesicle, pustule, ulcer. The ulcer heals slowly, within 2-3 weeks or even 1-2 months.
The angina-bubonic form of tularemia occurs with alimentary infection. Patients complain of a sore throat and difficulty swallowing. The palatine tonsils are swollen, hyperemic, with foci of necrosis and deposits that are difficult to remove and may resemble plaque in diphtheria of the pharynx. However, plaque in tularemia is often on one tonsil, never spreads beyond the tonsil and relatively quickly necrotizes with the formation of deep, slowly healing ulcers. The process in the pharynx is accompanied by regional lymphadenitis with possible suppuration and scarring.
The oculo-buccaneous form of tularemia occurs when the pathogen penetrates through the conjunctiva of the eye. Initially, conjunctivitis, papule and soon an ulcer with purulent discharge appear. Regional lymph nodes (submandibular, parotid, anterior cervical) become painful and dense. The process is usually unilateral, rarely bilateral. Corneal damage is possible.
The pulmonary form of tularemia occurs with airborne dust infection with damage to the bronchi and lungs. Patients complain of chest pain, dry cough, which may subsequently be accompanied by the release of mucopurulent sputum. The radiograph reveals enlarged hilar, paratracheal and mediastinal lymph nodes. The development of disseminated foci in the lungs, abscess, and pleurisy is possible.
The abdominal form of tularemia manifests itself in severe paroxysmal abdominal pain, which can imitate acute abdomen due to a sharp increase in mesenteric lymph nodes. Nausea, vomiting, flatulence, constipation, sometimes diarrhea, enlargement of the liver and spleen occur.
Generalized tularemia usually develops in weakened children with altered reactivity and is accompanied by general toxic symptoms. The disease begins suddenly with pronounced symptoms of intoxication. Convulsions, delirium, loss of consciousness are possible. Severe headaches, adynamia, anorexia, muscle pain are noted. Symmetrically located maculopapular rash often appears on the limbs, face and neck. Blood pressure is low, heart sounds are muffled. The liver and spleen are enlarged from the first days of the disease.
With tularemia, meningoencephalitis, myocarditis, and secondary pneumonia are possible.