Tularemia.

A 37-year-old woman experienced local symptoms on returning from a camping trip. Within three weeks she developed generalized symptoms and was hospitalized. Tularemia, and often overlooked cause of bubo formation, is endemic in Nevada. The diagnosis should be considered when patients who have visited such an area present with enlarged, painful lymph nodes, skin pustules, ulcers, headache, myalgia, malaise and nausea. Cultures tend to be negative, because the causative organism, Francisella tularensis, needs cysteine. While there are five clinical forms of tularemia, man tends to get the ulceroglandular form, mostly from insect bites. Treatment consists of intramuscular streptomycin 0.5 g every 12 hours until the temperature is normal.