Infection from inoculation through skin break typically results in a tender nodule with local lymphangitis. If transmitted through mucosa of the eyes, nose, or oropharynx, mucopurulent discharge with ulcerating granulomas may occur. If inhaled and causing systemic invasion, septicemia develops after 1 to 2 weeks, and the disease commonly manifests as pneumonia [61] . The most common manifestations include fever, myalgias, headache, and pleuritic chest pain. Lymphadenopathy or splenomegaly can often be found. A generalized papular or pustular rash is frequent. The septicemic form frequently results in death within 7 to 10 days.