Authors

GULSEN ISKENDER1, SABAHAT CEKEN1, HABIP GEDIK2, MUSTAFA CIHAT OGAN1, SELCUK KILIC3, MUSTAFA ERTEK1

Departments

1Ankara Oncology Education and Research Hospital, Infectious Diseases and Clinical Microbiology Clinic, Ankara - 2Dr.Sadi Konuk Education and Research Hospital, Infectious Diseases and Clinical Microbiology Clinic, İstanbul - 3Public Health Institution of Turkey, National Tularemia Reference Laboratory, Ankara, Turkey

Abstract

Introduction: Tularemia is a zoonotic disease of the northern hemisphere including Turkey. Here we describe the clinical and laboratory characteristics and response to treatment of patients with oropharyngeal tularemia caused by F. tularensis. subsp.holarc- tica.

Materials and methods: Datawere collected retrospectively from patients’ files. Serum, throat swabs and lymph node aspirates were obtained from suspected patients. The diagnosis was confirmed by a single titer of IgG ≥1: 160 or a seroconversion or detection of F.tularensis nucleic acid or isolation of it in a clinical specimen.

Results: All the patients had cervical or submandibular lymphadenopathy and malaise at admission. Lymphadenopathy was the single finding in 86.36% of patients. Microagglutination test was positive for F.tularensis subsp. holarcticain 95.45% of patients, polymerase chain reaction (PCR) assay of drained material was positive in 22.72% of patients but cultures were negative. Treatment delay and therapeutic failure was seen in 90.90% and 45.45% of the patients respectively. We found statistically significant relation- ship between treatment delay and therapeutic failure (P= 0.0005).

Discussion: Tularemia should be suspected whenever severe pharyngitis or tonsillitis and lymphadenophaties is unresponsive to β-lactam or macrolides in an endemic area. As treatment delay is an important risk factor for therapeutic failure, treatment should be started as soon as tularemia is suspected.

Keywords

Tularemia, zoonotic disease, lymphadenopathy, treatment

DOI:

10.19193/0393-6384_2016_2_59