A21.0 Ulceroglandular tularemia

Name of the Condition

• Ulceroglandular tularemia

Summary

Ulceroglandular tularemia is a localized form of tularemia, a bacterial infection caused by Francisella tularensis. It is characterized by a skin ulcer at the site of bacterial entry, typically accompanied by swollen regional lymph nodes (lymphadenopathy). This form results from direct contact with infected animals or arthropod bites, and symptoms may range from mild to severe depending on the extent of infection.

Causes

Ulceroglandular tularemia is caused by the bacterium Francisella tularensis. Infection occurs when the bacteria enter the skin through a break, such as a bite from an infected tick or deer fly, or direct contact with infected animal tissues (e.g., handling sick or dead wildlife). The bacteria multiply at the entry site, leading to localized tissue damage and lymph node involvement.

Risk Factors

• Exposure to ticks or biting insects in endemic areas.
• Handling or skinning wild animals, particularly rabbits or rodents.
• Occupational or recreational activities involving wildlife (e.g., hunting, farming).
• Living in or traveling to regions with known Francisella tularensis activity.

Symptoms

• A painful skin ulcer at the site of infection, often with a blackened center.
• Swollen, tender lymph nodes near the ulcer (lymphadenopathy).
• Sudden onset of fever and chills.
• Fatigue and muscle aches.
• Headache.

Diagnosis

Diagnosis is based on clinical presentation, including the characteristic ulcer and lymphadenopathy, combined with exposure history. Laboratory confirmation may involve culturing Francisella tularensis from ulcer swabs, lymph node aspirates, or blood, or using serologic tests to detect antibodies. Molecular methods like PCR can also identify the bacterium.

Treatment Options

• Antibiotics: Oral or intravenous antibiotics (e.g., streptomycin, gentamicin, or doxycycline) are the primary treatment to eliminate the bacteria.
• Lymph Node Care: Warm compresses or drainage may be used for large, painful lymph nodes, though incision is generally avoided to prevent spread.
• Supportive Care: Rest, hydration, and pain management may help alleviate symptoms.

Prognosis and Follow-Up

With prompt antibiotic treatment, most patients recover fully within weeks. Untreated cases can lead to prolonged illness or severe complications. Follow-up may include monitoring for resolution of symptoms and lymph node size, especially if lymphadenopathy persists.

Complications

• Spread of infection to other lymph nodes or organs.
• Bacteremia (bacteria in the bloodstream) leading to systemic illness.
• Prolonged fatigue or weakness.
• Rarely, sepsis or meningitis in severe cases.

Lifestyle & Prevention

• Avoid handling sick or dead wildlife, especially rabbits or rodents.
• Use insect repellent and wear protective clothing in tick- or fly-prone areas.
• Wear gloves when skinning animals or processing game.
• Practice good hand hygiene after outdoor activities.

When to Seek Professional Help

Seek medical attention if you develop a skin ulcer with swollen lymph nodes after outdoor activities, insect bites, or animal contact, especially if accompanied by fever. Early treatment improves outcomes and reduces complications.

Tips for Medical Coders

Use code A21.0 for ulceroglandular tularemia when the clinical documentation specifies this form, including a skin ulcer and regional lymphadenopathy. Ensure the diagnosis aligns with the characteristic symptoms and exposure history. Document the site of the ulcer and affected lymph nodes if available for specificity.