Tularemia in Otolaryngologic Practice: An Analysis of 127 Cases

Luotonen, Jukka; Syrjälä, Hannu; Jokinen, K.; Sutinen, S; Salminen, Anu

doi:10.1001/archotol.1986.03780010079015

Cited by 42 publications

(47 citation statements)

References 8 publications

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“…Physical examination shows redness and pustular changes in the mouth and pharyngeal mucous membranes, together with enlargement of regional neck lymph nodes [56][57][58]. If tularaemia is not suspected for epidemiological reasons, the diagnosis will most likely be missed and appropriate therapy not prescribed.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Tularaemia

Tärnvik¹,

Berglund²

2003

Eur Respir J

238

215

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Tularaemia is a zoonotic bacterial disease of the Northern hemisphere. The causative agent,Francisella tularensis, is spread to humans by direct contact with infected rodents or lagomorphs, aerogenic exposure, ingestion of contaminated food or water, or by arthropod bites. The prevalence of tularaemia shows a wide geographic variation. In some endemic regions, outbreaks occur frequently, whereas nearby rural parts of a country may be completely free.F. tularensisis a facultative intracellular pathogen and its primary mammalian target cell is the mononuclear phagocyte. When tularaemia is acquiredviathe skin, a primary ulcer is often detected and in general, regional lymph nodes become prominently enlarged. When contracted by inhalation, the disease may present with pneumonia. Nearly as frequent, however, is the development of fever and general illness with no respiratory symptoms and no pulmonary radiological changes. When present, the changes vary widely and may sometimes include hilar enlargement indistinguishable from that of lymphoma.Within an outbreak, the first case of tularaemia is not always readily diagnosed. A decade may have lapsed since the disease was encountered and its existence may be more or less forgotten. The difficulty refers especially to the respiratory form, in which symptoms are less specific. In cases of atypical pneumonia or acute febrile disease with no local symptoms, a history of exposure to hares or rodents or merely living in an endemic region should be sufficient to include tularaemia among differential diagnoses.The microbiological diagnosis of tularaemia relies mainly on serology, and the treatment on broad-spectrum antibiotics. For decades, a live vaccine has been successfully used in risk groups but is presently not available due to difficulties in standardisation.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Tularaemia

Tärnvik¹,

Berglund²

2003

Eur Respir J

238

215

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“…However, oropharyngreal tularemia is the most frequently observed type in some eastern European countries, particularly in Kosovo, Turkey, and Bulgaria [6,7,15]. In contrast to cases found in Sweden [16] and Finland [17], oropharyngreal tularemia is also the most common manifestation in Norway [18].…”

Section: Discussionmentioning

confidence: 99%

“…We suggest that the route of transmission might be by ingestion of uncooked food or, less likely, contaminated water. By comparison, as in other European counties [6,17], most of the outbreaks reported in Turkey over the last 20 years were related to the consumption of contaminated water [5].…”

Section: Discussionmentioning

confidence: 99%

Tularemia in Bulgaria 2003-2004

Komitova

Nenova

Padeshki

et al. 2010

J Infect Dev Ctries

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Introduction: Tularemia is an uncommon but potentially fatal zoonosis. А second outbreak of tularemia in Bulgaria, about 40 years after the first, occurred in 1997 in two western regions, near the Serbian border. In 2003 tularemia reemerged in the same foci. This retrospective study aimed to evaluate the clinical characteristics and the efficacy of antibiotic therapy in a tularemia resurgence in the Slivnitza region in [2003][2004]. Methodology: A total of 26 cases were evaluated. Using medical records, the following data were collected for all patients: symptoms, physical signs, and microbiology results of agglutination tests, cultures and PCR assays. Results: Twenty-four of 26 suspected tularemia patients were laboratory confirmed by agglutination test and/or culture. Fifteen (57.7%) patients had clinical presentation compatible with oropharyngeal, 8 (30.8%) with glandular, and 3 (11.5%) with oculoglandular tularemia. The most frequent symptoms were swollen neck (84.6%) and sore throat (76.9%). Lymphadenopathy (100%) was the most common finding. Francisella tularensis (F. tularensis) was detected by PCR, providing a definitive diagnosis in 82.3% of the cases. All the patients were treated with antibiotics considered effective against F. tularensis; however, therapeutic failure was observed in 23.1% of the cases, which was related to a delay in the initiation of antibiotics. Conclusion: The tularemia outbreak in west Bulgaria near the Serbian border was probably food-borne, associated with a surge in the rodent population. The oropharyngeal form was the most common. Although the disease runs a benign course, late initiation of antimicrobial therapy might delay complete recovery.

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“…Bis zu 45% der Patienten mit Tularämie entwickeln Symptome im Kopf-Hals-Bereich [7,17,18]. Aufgrund der Übertragbarkeit über Aerosole und der dabei sehr niedrigen erforderlichen Infektionsdosis wurde bereits sehr früh das Potenzial von F. tularensis tularensis als biologische Waffe erkannt [1].…”

Section: üBertragung Und Klinikunclassified