Symptoms & Subtypes: The Forms of Tularemia

The way Tularemia affects your body depends almost entirely on how the bacteria entered your system ^[1][2]. Because the bacteria can enter through the skin, eyes, mouth, or lungs, there are six recognized “forms” or subtypes of the disease ^[3]. Understanding which form you have helps your medical team choose the right tests and monitor for specific symptoms. The incubation period (the time between exposure and when you feel sick) is typically 3 to 5 days, but can take up to 14 days.

The Most Common Forms: Skin and Glandular Entry

Most cases of Tularemia involve the skin or the lymph nodes (small, bean-shaped glands that act as filters for the immune system).

• Ulceroglandular Tularemia: This is the most frequent form of the disease ^[4]. It usually occurs after a tick or deer fly bite, or from handling an infected animal ^[3].
  • Main Symptoms: A painful skin ulcer (an open sore) develops at the site where the bacteria entered ^[3]. This is accompanied by swollen, painful lymph nodes in the area near the sore (for example, in the armpit if the sore is on the arm) ^[5].
  • Wound Care: It is important to ask your doctor for specific wound care instructions (such as whether to keep it covered or apply specific ointments). Note that these ulcers can sometimes leave a small scar after healing.
• Glandular Tularemia: This form is very similar to the ulceroglandular type and is typically contracted the same way ^[6].
  • Main Symptoms: You will have high fever and swollen, painful lymph nodes, but no skin ulcer will be visible ^[7].

Forms Involving the Head and Throat

When the bacteria enter through the face—either by touch or by eating/drinking—they cause specific localized symptoms.

• Oropharyngeal Tularemia: This occurs from eating undercooked meat of an infected animal or, more commonly, drinking contaminated water ^[8].
  • Main Symptoms: It often looks like a severe case of “strep throat.” Symptoms include a sore throat, trouble swallowing, and swelling of the lymph nodes in the neck ^[8][9].
• Oculoglandular Tularemia: This rare form happens when the bacteria enter the eye, often because someone touched their eye after handling an infected animal or was splashed with contaminated water ^[10].
  • Main Symptoms: It causes intense inflammation of the eye (conjunctivitis), swelling of the eyelid, and painful swelling of the lymph nodes in front of the ear or in the neck ^[11].

The Most Serious Forms: Inhalation and Systemic Spread

These forms are generally considered more severe and require urgent medical attention ^[12][1].

• Pneumonic Tularemia: This form occurs when you breathe in the bacteria ^[13]. This can happen while mowing a lawn, weed-whacking, or clearing brush in areas where infected animals have lived, as these activities can “kick up” the bacteria into the air ^[14].
  • Main Symptoms: These include a dry cough, chest pain, and difficulty breathing ^[15]. Because it looks like other types of pneumonia, it can sometimes be difficult to diagnose quickly ^[16].
• Typhoidal Tularemia: This is a systemic form, meaning the bacteria are affecting the entire body rather than one specific entry point ^[12].
  • Main Symptoms: It is characterized by a high, prolonged fever, extreme exhaustion, and weight loss, but it lacks the skin sores or obviously swollen lymph nodes seen in other forms ^[12][17].

Summary of Subtypes and Causes

Regardless of the form, most patients experience “flu-like” symptoms such as sudden fever, chills, headache, and muscle aches as the body begins to fight the infection ^[5][3]. Because Tularemia is rare, if your symptoms do not improve with standard “first-line” antibiotics (like those used for common throat or skin infections), it is important to remind your doctor about any possible contact you had with wildlife or insects ^[18][2].