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Skin-nontumor / Clinical Dermatology

Infectious disorders


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 28 April 2011, last major update April 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Caused by bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares), transmitted by ticks, deer flies

Clinical description

● Symptoms: sudden fever, chills, headaches, diarrhea, muscle aches, joint pain, dry cough, progressive weakness
● Also pneumonia, skin/mouth ulcers, lymphadenopathy, eye involvement
● Diagnosis: serology and culture, direct immunofluorescence, PCR

Clinical images

Girl with ulcerating lymphadenitis in Kosovo

Deer fly

Microscopic description

● Often intracellular and intercellular edema of epidermis
● Dermal edema and telangiectasia and mild perivascular infiltrate
● Early cutaneous ulcer is characterized by fibrinopurulent exudate and accompanied by infiltrate of lymphocytes and macropahges
● Later is suppurative granulomatous inflammation of skin, which migrates to regional lymph nodes
● Central zone of granuloma contains necrotic material and karyorrhectic debris; intermediate zone has giant cells surrounding epithelioid histiocytes; outer mantle zone contains lymphocytes, histiocytes, plasma cells and extravasated red cells

Micro images

Various images

Additional references

Centers for Disease Control: outbreak in Kosovo

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Tularemias

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