Radiologic evidence of pneumonia or mediastinal lymphadenopathy is most common with typhoidal disease but may or may not be present in all other forms of tularemia. Patients have unilateral, painful, purulent conjunctivitis with preauricular or cervical lymphadenopathy. Chemosis, periorbital edema, and small nodular lesions or ulcerations of the palpebral conjunctiva are noted in some patients. Oropharyngeal tularemia refers to primary ulceroglandular disease confined to the throat. It produces an acute exudative or membranous pharyngotonsillitis with cervical lymphadenopathy.
Pneumonic tularemia is an illness characterized primarily by pneumonia.
Pneumonia is common in tularemia. The case fatality rate without treatment is approximately 5 percent for the ulceroglandular form and 35 percent for the typhoidal form. All ages are susceptible, and recovery is followed by permanent immunity. Isolation represents a clear hazard to laboratory personnel and should only be attempted in BL-3 laboratory. The diagnosis can be established retrospectively serologically.