Clinical manifestation

Ulceroglandular variant: organism usually gaining entry via scratch or abrasion; ulcer at the site of entry begins as tender papule and eventually ulcerates; sharply demarcated border with a yellowish exudate; base of the ulcer with yellow exudate becomes black; regional lymphadenopathy Glandular variant: similar to ulceroglandu-lar form except for absence of skin lesion Oculoglandular variant: organism enters via the conjunctivae after inoculation from either splashing of blood or rubbing of eyes after contact with infectious materials; unilateral, painful, purulent conjunctivitis with preauricular or cervical lymphadenopathy Oropharyngeal variant: occurs after eating poorly cooked rabbit meat; sore throat; abdominal pain; nausea; vomiting; diarrhea; and; occasional gastrointestinal bleeding

Pneumonic variant: occurring after inhalation of organism; pneumonia also sometimes occurs after hematogenous spread in patients with ulceroglandular tularemia or typhoidal tularemia; dry cough; dyspnea; and pleuritic-type chest pain Typhoidal (septicemic) variant: represents bacteremia; fever; chills; myalgias; malaise; weight loss, often with subsequent pneumo-

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