Evaluation of tularaemia courses: a multicentre study from Turkey

Abstract

In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.

Tularemia: A Rare Cause of Neck Mass

“…Samples taken from 19 patients (76%) were sent for pathological examination; 13 patients (52%) were reported with cytological findings consistent with abscess content and six (24%) were reported as having granulomatous inflammatory reaction. In the examination of abscess material, 25 patients (100%) Running wound in the neck 3 (12) were reported as ARB negative. All patients were initiated with streptomycin therapy at appropriate doses for 10 days in accordance with the field guideline of the Ministry of Health for tularemia.…”

“…It was reported that almost half of the patients had suppurative inflammation, and only 8% had caseous necrosis. This situation can be interpreted as tuberculosis lymphadenitis in patients having caseification, and it can result in wrong approaches with regard to treatment (12,14).…”

“…If abscess recurs, drainage can be performed with a small incision. Excision of the lymph node can be performed in a few patients with caseification (12,14). In our series, the lymph nodes of patients in their necks were reduced after 10-day streptomycin therapy.…”

Tularemia Associated with Natural Water Sources: Two Case Reports and Review of the Literature

“…Erdem et al [24] Tularemia is usually transmitted by direct contact with rodents or drinking and/or well water contaminated by rodents [1,3,9,17] . Our cases were infected probably through a contaminated drinking water source.…”

“…In a multicenter study from Turkey; treatment failure was considered to have occured 48% of patients [24] . The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment, the formation of new lymphadenomegalies under treatment, and persisting complaints despite two weeks of treatment [24] .…”