Symptoms of tularemia appear between three to five days after exposure to the bacteria but can take as long as 14 days. There are at least six types of clinical symptoms, depending on the route of infection and the strain of bacteria.
Ulceroglandular: Patients have large, tender lymph nodes and a non-healing skin ulcer at the site of infection, often with fatigue, chills, and malaise.
Glandular: Patients have one or more enlarged painful nodes that may be filled with pus.
Pneumonic (pulmonary): This may be a primary infection following inhalation of the organisms or secondary to blood infection; with symptoms that may include a non-productive cough, difficulty breathing and chest pain.
Typhoidal: This is a rare form, with enlarged and inflamed lymph nodes, blood poisoning, abdominal pain, diarrhea, vomiting and gastrointestinal bleeding.
Oropharyngeal: This form results from ingestion of bacteria in food or water leading to painful sore throat (pharyngitis), abdominal pain, diarrhea, and vomiting.
Oculoglandular: Patients have eye pain, redness, and discharge with enlarged lymph nodes of the neck or near the ears and usually accompanied with fever, chills and malaise.