Ulceroglandular tularemia presents with a local ulcer and regional lymphadenopathy, fever, chills, headache and malaise. Typhoidal tularemia presents with fever, headache, malaise, substernal discomfort, prostration, weight loss and a non-productive cough. Physical findings are usually non-specific. Chest x-ray may reveal a pneumonic process, mediastinal lymphadenopathy or pleural effusion.
Routine culture is possible but difficult.
The diagnosis can be established retrospectively by serology. A live, attenuated vaccine is available as an investigational new drug. It is administered once by scarification. A two week course of tetracycline is effective as prophylaxis when given after exposure. Less commonly, inhalation of contaminated dusts or ingestion of contaminated foods or water may produce clinical disease.