The clinical manifestations depend on the route of infection. It can be transmitted through a bite from an infected arthropod or handling of infected animal carcass, ingestion of contaminated food or water, or inhalation of droplets [44] , and respectively patients can present with ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, or pneumonic tularemia [45] . The incubation period usually comprises 3 to 6 days.