Imitation is the sincerest form of flattery. First, 2D platformers were flattered, and then fighting games were complimented. Now, the Survival Horror category is getting its fare share of lip service. Fortunately, Extermination's imitation is on the better side of the genre.
The weapons system, while not completely original, is an interesting twist from the standard fare. Players have only a knife and one gun. That one gun can be modified to fire shotgun shells, napalm tanks, and missiles. These are not just different weapons, as most of these add-ons can be fired along with the standard rifle.
Another innovation is the infections system. The player not only has the normal health bar, but also an infection meter. The more Dennis, the main character, is hit by poisonous attacks, the more infected he becomes. Dennis must reach a vaccination bed to cure himself, or if he can't find one, he can keep the infection at by using booster shots. If the meter reaches 100% infection, it will start to rapidly deplete his health.
Calling the voice acting and lip synching sub par in Extermination would be a severe understatement. Many times you will see a character's lips move but the audio will not start for another couple of seconds. The story line is hardly enthralling. It's the same old "crazy virus makes zombies that take over a large portion of a secluded area and you have to stop them" story that has been played to death.
The camera also has problems. You will often enter a room where an enemy is on your flank, however your character's rotation speed allows the enemy to land an attack before you can even face him. This is a very cheap way of make the game challenging.
Extermination is still a fun game even with its flaws.