A 44-year-old farmer presented with high-grade fever for 4 days. On examination, an ulcer was found at the right-hand region along with painful cervical lymphadenopathy. History revealed a bite of an animal 4 days ago. A papule was formed which later progressed to form an ulcer. Erythematous, maculopapular rash all over the body along with erythema nodosum on lower limbs were present. Swabs from the ulcer and biopsy from the lymph nodes were taken and sent for examination. Gram staining was done. It showed growth on chocolate agar, BCYE agar and media supplemented with cysteine. What is the drug of choice of the above organism: -

This is a case of Ulceroglandular tularemia (i/v/o of the clinical history and history of an animal bite) 1st image the classical ulcer seen in tularemia. Gram stain shows tiny, pleomorphic, poorly staining gram-negative coccobacillus. Tularemia is a rare infectious disease that typically attacks the skin, eyes, lymph nodes and lungs. Tularemia -- also called rabbit fever or deer fly fever -- is caused by the bacterium Francisella tularensis. Ulceroglandular tularemia- This is the most common form of the disease. Signs and symptoms include: 1. A skin ulcer that forms at the site of infection -- usually an insect or animal bite 2. Swollen and painful lymph glands 3. Fever 4. Chills 5. Headache 6. Exhaustion The drug of choice is streptomycin. Doxycycline is a first line drug. Other aminoglycosides are reserved for severe cases.