Evaluation of tularemia cases focusing on the oculoglandular form

Abstract

Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis. The oculoglandular form is one of the rarest forms. In this study, evaluated tularemia patients, focusing on the ocular form and the efficacy of early antibiotic therapy. Methodology: During a tularemia outbreak, the epidemiological and clinical findings, laboratory assays, and drugs used for the treatment of 48 patients were recorded prospectively. The diagnosis of tularemia was confirmed with microagglutination test (MAT) as well as clinical findings. Results: The mean age of the subject was 48.6 years; 23 (47.9%) of them were female. Thirty-six (81.25%) patients had clinical presentation compatible with oropharyngeal tularemia, seven (14.58%) with oculoglandular tularemia, and two (4.1%) with ulceroglandular tularemia. The most common symptoms were fever (91.6%) and sore throat (81.2%), and the most common findings were lymphadenopathy (91.6%) and tonsillopharyngitis (81.2%). In the oculoglandular form, fever, lymphadenopathy, periorbital edema, conjunctival injection, and chemosis were found. The most distinctive ophthalmic feature was follicular conjunctivitis and conjunctival epithelial defects. Forty-five cases had positive serological results with MAT. All the patients were treated with antibiotics considered effective against F. tularensis, and topical antimicrobial treatment was given to the patients with oculoglandular tularemia. Twenty-six (54.16%) patients, who were admitted within three weeks of the onset of symptoms, recovered without sequel. Conclusions: During tularemia outbreaks, ocular involvement should be considered carefully. The early administration of appropriate treatment will be more effective in resolving the infection and preventing complications. Along with systemic antibiotic therapy, topical treatment will help recovery.

Oculoglandular Tularemia From Crushing an Engorged Tick

“…Our patient has an elevated serum (mainly unconjugated) bilirubin level. Although tularemia may complicate granulomatous hepatitis [ 10 ], in our patient this was not the case, as he had no elevated liver enzymes. Later, in a repeated test, results showed similar bilirubin levels with otherwise normal hepatic function.…”

Revenge of the Tick: Tick-Borne Diseases and the Eye in the Age of Climate Change and Globalisation

“…Ophthalmic complaints previously reported in oculoglandular tularaemia include photophobia, excessive lacrimation or epiphora, foreign body sensation, sensation of soreness, lid oedema, floaters, crusting on eyelashes, and hyperaemia [128][129][130][131][132]. Ophthalmic manifestations include conjunctival chemosis, episcleritis, ptosis, purulent secretions, and periorbital oedema [129].…”

Tularemia treatment: experimental and clinical data

“…Large OP tularemia case series have been reported in Turkey where these infections predominate and occur as outbreaks mainly related to the consumption of contaminated water ( Meric et al, 2008 ; Ulu-Kilic et al, 2013 ; Erdem et al, 2014 ; Gozel et al, 2014 ; Table 7 ). Many other small series or sporadic OP tularemia cases have been reported involving more than 200 patients ( Arikan et al, 2003 ; Chitadze et al, 2009 ; Sencan et al, 2009 ; Komitova et al, 2010 ; Kızıl et al, 2012 ; Dentan et al, 2013 ; Eren Gok et al, 2014 ; Karakas et al, 2014 ; Uzun et al, 2015 ; Esmaeili et al, 2021 ; Binay et al, 2023 ).…”