Mucosal lesions become gradually painful. Initial symptoms include nasal obstruction and bleeding. Many subclinical cases occur for each clinically recognized case. Malnutrition has been shown to contribute to the development of clinical disease. Onset is insidious.
Fever can be continuous, intermittent, or remittent and it can recur at irregular intervals.
Initially, the lesion is a small red papule, up to 2 cm in size. The papule ultimately ulcerates. The ulcer has raised edges with surrounding dusky red skin. The ulcers can be moist or open with seropurulent exudate or dry with a crusted scab. Sores usually are found on exposed areas of skin, especially the extremities and face.