A chronic cutaneous form with lymphangitis and regional adenopathy is also frequent. Aerosol infection produced by a BW weapon containing B. mallei could produce any of these syndromes. The incubation period ranges from 10- 14 days, depending on the inhaled dose and agent virulence. The septicemic form begins suddenly with fever, rigors, sweats, myalgia, pleuritic chest pain, photophobia, lacrimation, and diarrhea. Physical examination may reveal fever, tachycardia, cervical adenopathy and mild splenomegaly.
Blood cultures are usually negative until the patient is moribund.
Mild leukocytosis with a shift to the left or leukopenia may occur. The pulmonary form may follow inhalation or arise by hematogenous spread. Systemic symptoms as described for the septicemic form occur. The chronic form is unlikely to be present within 14 days after a BW aerosol attack. It is characterized by cutaneous and intramuscular abscesses on the legs and arms.