| • | painful, dirty, purulent |
| • | painful inguinal, usually unilateral lymphadenopathy |
| • | break down to buboes (25%) |
| • | “kissing lesions” secondary to autoinoculation |
diagnosis:
| • | culture on heart infusion agar special media not widely available = blood of sheep, rabbit plus vancomycin (because lesions are dirty) |
| • | gram stain = “school of fish”; gram (-) coccobacillus (short and compact) (look like a “closed safety pin”) |
| • | mnemonic – “at the fish school there are kissing contests” |
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