Tularemia in children: Evaluation of clinical, laboratory and treatment outcomes of 15 tularemia cases

Abstract

Introduction: Tularemia is a zoonotic diseases caused by Francisella tularensis. The aim of this study was to evaluate the clinical and laboratory findings of 15 children with the diagnosis of tularemia.Materials and Methods: Fifteen cases admitted with fever, sore throat, lymphadenopathy and a F. tularensis antibody titer of 1/160 and above in the microagglutination test (MAT) were evaluated retrospectively. Their sociodemographic characteristics, contact with animals, history of tick bite, duration of complaints, clinical and laboratory findings, treatments and clinical courses were studied.Results: The mean age of patients was 11.5 +/- 5.1 (3-17) years and 61.3% were male. Fiftythree percent of the patients were living in rural areas, and had contact with contaminated water. Swelling in the neck (93.3%), sore throat (66.7%) and fever (66.7%) were the most frequently observed symptoms. Oropharyngeal tularemia (66.7%) was predominated. In 27% of the patients LAPs were drained surgically, and in 13.3% of cases they were drained by itself. The mean duration between onset of tularemia symptoms and diagnosis was 53 +/- 45.3 (5150) days. Sixty percent of patients were received beta-lactam-antibiotics before admission. It was noted that 6 patients with suppurative lymph nodes were admitted to hospital within median 61 (20-150) days, while others were admitted within median 35 (5-75) days (p< 0.05). Mean leukocyte count was 8558.6 +/- 1384.5 (6030-11400)/mm3, mean CRP was 5.8 +/- 2.9 (1-6.7) mg/dl, and mean ESR was 33.1 +/- 28.9 (6-103) mm/h. MAT showed that titers ranged from 1/160 to 1/1280. Gentamicin was given in seven patients (47%), streptomycin in five patients (33%), and doxycycline in 3 patients (20%).Conclusions: Tularemia should to be taken into account in the differential diagnosis in patients having tonsillopharyngitis and cervical lymphadenopathy without response to beta-lactam antibiotics in rural areas.