Typhoidal tularemia is the systemic form that occurs in 30% of cases after any form of acquisition, but most commonly after inhalation of infectious aerosols. From the regional lymph nodes, the organisms spread to various organs, such as the liver, spleen, lungs, kidneys, intestines, CNS [44, 45] . It would be the most likely form to be encountered after use of francisella tularensis as a bioweapon. It is characterized by high fevers, headache, myalgias, prostration, vomiting, diarrhea; renal failure, rhabdomyolysis, pericarditis, meningitis, and erythema nodosum [47] . Approximately 80% of patients have pneumonia.