Which signs and symptoms would support an initial diagnosis of tularemia?

• A. Fever, chills, headache, and malaise.
• B. Vomiting, diarrhea, and fatigue.
• C. The nurse smells the odor of bitter almonds.
• D. Visual and gastrointestinal disturbances.

Answer: (A)

Tularemia typically begins as a febrile, flu‑like illness with nonspecific systemic symptoms. The combination of fever, chills, headache, and malaise reflects this early, general inflammatory response after exposure to the bacterium. That makes the presentation described in the first set of signs the best clue for an initial tularemia diagnosis.

The other options mix in symptoms that aren’t characteristic early signs: vomiting and diarrhea can occur in various illnesses but aren’t the classic early tularemia pattern; the bitter almond odor is associated with cyanide exposure, not tularemia; and visual disturbances aren’t a typical initial feature of tularemia. In practice, a clinician would also consider exposure history (wildlife, vectors, or contaminated water) and watch for later signs like regional lymphadenopathy if the ulceroglandular form develops.