Tularemia

The rash of tick tularemia is seen here on the arm of a 5-year-old boy. He also had a tick bite on his back that became necrotic and ulcerated. His axillary lymph nodes became palpable within 2 weeks after the tick bite. The diagnosis of ulceroglandular tularemia was confirmed by a blood agglutination titer of 1:4000. (An agglutination titer greater than 1:80 is diagnostic, although often the titer is not elevated during the first week.) The patient responded well to antibiotic therapy; the prognosis for tularemia is usually good. Ulceroglandular tularemia is the most common form of tick tularemia. All forms provoke fever, chills, headache, and myalgia to varying degrees.

(Case and photograph courtesy of W. B. Wadlington, MD.)