Skin nontumor
Infectious disorders

Topic Completed: 1 April 2011

Minor changes: 2 April 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Tularemia [title] skin

Mowafak Hamodat, M.B.Ch.B., M.Sc.
Page views in 2019: 421
Page views in 2020 to date: 155
Cite this page: Hamodat M Tularemia. website. Accessed August 8th, 2020.
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
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