The clinical picture of tularemia

The incubation period up to 21 days. Tularemia begins abruptly, without prodromal period. Characteristic temperature rise to 38-39 degrees, the chills, headaches, muscle pain, General weakness, dizziness, lack of appetite; vomiting, delirium, nasal bleeding. There is a flushing of the face, throat, conjunctive. Duration of fever from 5-7 to 30 days and more. There are the following types of fever; remitting incorrectly intermittently, wavy, subfebrile. Often relapsing-remitting and wrong intermittently types. In the blood, lakopenia with moderate left shift formula, lymphocytes, monocytosis, accelerated ROHE. There are severe, moderate and slight (blurred, abortifacient, afebrile) the disease. Following clinical forms of tularemia (table).

Clinical forms and ways of infection tularemia
Clinical forms of tularemia Ways of infection
Bubonic
Ulcerative-bubonic
Oculo-bubonic
Through the skin and the mucous membranes of eyes
Angina-bubonic
Abdominal
Through the mouth
Pulmonary Through the respiratory tract
Generalized (primarily septic) Any way
cervical bubo
Fig. 1. Cervical bubo
oculo-bubonic form of tularemia
Fig. 2. Oculo-bubonic form of tularemia.

Bubonic form accompanied by the development of regional lymphadenitis (Fig. 1). Bubny there are single and multiple, one - and two-sided, with value up to chicken eggs and more. Localization buboes depends on the place of the introduction of the pathogen (armpit, the neck, groin, and so on). Bubny can be established, pussy to soften, to sklerozirovanie as a result of proliferation of connective tissue. The resolution of Bubnov is slow, in waves. The duration of the disease is delayed up to 3-4 months. In the presence of inflammatory changes of the skin in the place of the entrance gate occurs ulcerative-bubonic form of tularemia. The skin may develop (consistently) stain, papules, vesicles, pustules, and ulcers.
Oculo-bubonic form occurs with conjunctivitis, submandibular, cervical bubo (Fig. 2). Possible loss of vision.
Angina-bubonic form is accompanied by redness and grayish-white-sided raids on the tonsils. Further possible necrosis and ulceration. Bow and tongue swollen and giperemiei. Marked pain and difficulty swallowing.
For abdominal forms typical nausea and severe abdominal pain due to the development of mesenteric Bubnov that can simulate the so-called acute abdomen.
Pulmonary form (primary) is characterized by primary inflammation in the lungs. With the defeat of only upper respiratory tract develops bronchietasis option, which is characterized by diffuse bronchitis and dry cough without cold. Ends with recovery within 8-12 days. When tularemia focal pneumonia tapped dry and wet traiterous wheezing. She described as heavy, creeping, relapsing, nekrotizirutee. Different sluggish and backbreaking over, lasts up to 2 months. and more. There is a tendency to merge separate foci on the type of equity pneumonia. Confirmed by x-ray data. Possible complications such as bronchiectasis, gangrene light, dry and exudative pleurisy.
Secondary (metastatic) pneumonia is a complication of bubonic and other forms of tularemia. Proceeds easier primary, but long - term, with acute and recurrent.
Generalized form (primary septic). Typical weakness, myalgia, loss of appetite, undulating fever within 2-4 weeks or more, in severe cases, delusions. Often there are skin rash: roseola, papules, vesicles, petechiae, followed by peeling.