Skin inflammatory (nontumor)
Infectious disorders

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 19 October 2018, last major update April 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Tularemia [title] skin

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Cite this page: Hamodat, M. Tularemia. website. Accessed January 23rd, 2019.
Definition / general
  • Caused by bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares), transmitted by ticks, deer flies
Clinical features
  • Symptoms: sudden fever, chills, headaches, diarrhea, muscle aches, joint pain, dry cough, progressive weakness
  • Also pneumonia, skin/mouth ulcers, lymphadenopathy, eye involvement
  • Diagnosis: serology and culture, direct immunofluorescence, PCR
Clinical images

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Deer fly

Microscopic (histologic) description
  • Often intracellular and intercellular edema of epidermis
  • Dermal edema and telangiectasia and mild perivascular infiltrate
  • Early cutaneous ulcer is characterized by fibrinopurulent exudate and accompanied by infiltrate of lymphocytes and macropahges
  • Later is suppurative granulomatous inflammation of skin, which migrates to regional lymph nodes
  • Central zone of granuloma contains necrotic material and karyorrhectic debris; intermediate zone has giant cells surrounding epithelioid histiocytes; outer mantle zone contains lymphocytes, histiocytes, plasma cells and extravasated red cells
Additional references