ulceroglandular

Ulceroglandular refers to a clinical presentation characterized by a primary skin ulcer at the site of inoculation accompanied by regional lymphadenopathy. It is most commonly described in ulceroglandular tularemia, a form of tularemia caused by the bacterium Francisella tularensis.

Clinical features typically begin with a painful, erythematous skin lesion that may start as a papule and rapidly progress to an ulcer with a necrotic center. Nearby regional lymph nodes become enlarged and tender, and may suppurate. Systemic symptoms such as fever, malaise, myalgias, and fatigue are common. The incubation period is usually several days.

Transmission factors include handling infected animals (notably rabbits and hares), bites from arthropods such as ticks or deer flies, and, less commonly, ingestion or inhalation of contaminated material. The pathogen is an intracellular bacterium, and ulceoglandular tularemia can progress without treatment to more extensive disease.

Diagnosis relies on a combination of clinical suspicion, exposure history, and laboratory testing. Serology detecting antibodies to Francisella tularensis is commonly used, with confirmation or supportive evidence from PCR testing on tissue, blood, or aspirates. Cultures can be performed but require specialized biosafety facilities due to biosafety concerns.

Treatment typically involves antibiotics such as streptomycin or gentamicin as first-line options; alternatives include doxycycline or ciprofloxacin, with therapy usually extending for 10 to 14 days or longer based on clinical response. Early initiation improves outcomes and reduces the risk of systemic involvement.

Prevention focuses on reducing exposure to animal reservoirs and vectors, using protective clothing and insect repellent in endemic areas, and careful handling of potentially infected animals.