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Troha K, Božanić Urbančič N, Korva M, Avšič-Županc T, Battelino S, Vozel D. Vector-Borne Tularemia: A Re-Emerging Cause of Cervical Lymphadenopathy. Trop Med Infect Dis 2022; 7:tropicalmed7080189. [PMID: 36006281 PMCID: PMC9412492 DOI: 10.3390/tropicalmed7080189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/16/2022] Open
Abstract
Tularemia is a zoonosis caused by the highly invasive bacterium Francisella tularensis. It is transmitted to humans by direct contact with infected animals or by vectors, such as ticks, mosquitos, and flies. Even though it is well-known as a tick-borne disease, it is usually not immediately recognised after a tick bite. In Slovenia, tularemia is rare, with 1–3 cases reported annually; however, the incidence seems to be increasing. Ulceroglandular tularemia is one of its most common forms, with cervical colliquative lymphadenopathy as a frequent manifestation. The diagnosis of tularemia largely relies on epidemiological information, clinical examination, imaging, and molecular studies. Physicians should consider this disease a differential diagnosis for a neck mass, especially after a tick bite, as its management significantly differs from that of other causes. Tularemia-associated lymphadenitis is treated with antibiotics and surgical drainage of the colliquated lymph nodes. Additionally, tularemia should be noted for its potential use in bioterrorism on behalf of the causative agents’ low infectious dose, possible aerosol formation, no effective vaccine at disposal, and the ability to produce severe disease. This article reviews the recent literature on tularemia and presents a case of an adult male with tick-borne cervical ulceroglandular tularemia.
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Affiliation(s)
- Kaja Troha
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Kukla R, Kračmarová R, Ryšková L, Bavlovič J, Pellantová V, Bolehovská R, Fajfr M, Pavlík I, Boštík P. Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review. Ticks Tick Borne Dis 2021; 13:101893. [PMID: 34990926 DOI: 10.1016/j.ttbdis.2021.101893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.
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Affiliation(s)
- Rudolf Kukla
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Renata Kračmarová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Lenka Ryšková
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Jan Bavlovič
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic; Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defence, Trebešská 1575, 50001 Hradec Králové, Czech Republic
| | - Věra Pellantová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Radka Bolehovská
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Miroslav Fajfr
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Ivo Pavlík
- Faculty of Regional Development and International Studies, Mendel University in Brno, tr. Generála Píky 7, 61300, Brno, Czech Republic
| | - Pavel Boštík
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic.
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Reichel CA. Rare Diseases of the Oral Cavity, Neck, and Pharynx. Laryngorhinootologie 2021; 100:S1-S24. [PMID: 34352905 PMCID: PMC8432966 DOI: 10.1055/a-1331-2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diseases occurring with an incidence of less than 1-10 cases per 10 000 individuals are considered as rare. Currently, between 5 000 and 8 000 rare or orphan diseases are known, every year about 250 rare diseases are newly described. Many of those pathologies concern the head and neck area. In many cases, a long time is required to diagnose an orphan disease. The lives of patients who are affected by those diseases are often determined by medical consultations and inpatient stays. Most orphan diseases are of genetic origin and cannot be cured despite medical progress. However, during the last years, the perception of and the knowledge about rare diseases has increased also due to the fact that publicly available databases have been created and self-help groups have been established which foster the autonomy of affected people. Only recently, innovative technical progress in the field of biogenetics allows individually characterizing the genetic origin of rare diseases in single patients. Based on this, it should be possible in the near future to elaborate tailored treatment concepts for patients suffering from rare diseases in the sense of translational and personalized medicine. This article deals with orphan diseases of the lip, oral cavity, pharynx, and cervical soft tissues depicting these developments. The readers will be provided with a compact overview about selected diseases of these anatomical regions. References to further information for medical staff and affected patients support deeper knowledge and lead to the current state of knowledge in this highly dynamic field.
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Affiliation(s)
- Christoph A Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, KUM-Klinikum, Ludwig-Maximilians-Universität München, München
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Hennebique A, Boisset S, Maurin M. Tularemia as a waterborne disease: a review. Emerg Microbes Infect 2019; 8:1027-1042. [PMID: 31287787 PMCID: PMC6691783 DOI: 10.1080/22221751.2019.1638734] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/27/2019] [Indexed: 12/20/2022]
Abstract
Francisella tularensis is a Gram-negative, intracellular bacterium causing the zoonosis tularemia. This highly infectious microorganism is considered a potential biological threat agent. Humans are usually infected through direct contact with the animal reservoir and tick bites. However, tularemia cases also occur after contact with a contaminated hydro-telluric environment. Water-borne tularemia outbreaks and sporadic cases have occurred worldwide in the last decades, with specific clinical and epidemiological traits. These infections represent a major public health and military challenge. Human contaminations have occurred through consumption or use of F. tularensis-contaminated water, and various aquatic activities such as swimming, canyoning and fishing. In addition, in Sweden and Finland, mosquitoes are primary vectors of tularemia due to infection of mosquito larvae in contaminated aquatic environments. The mechanisms of F. tularensis survival in water may include the formation of biofilms, interactions with free-living amoebae, and the transition to a 'viable but nonculturable' state, but the relative contribution of these possible mechanisms remains unknown. Many new aquatic species of Francisella have been characterized in recent years. F. tularensis likely shares with these species an ability of long-term survival in the aquatic environment, which has to be considered in terms of tularemia surveillance and control.
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Affiliation(s)
- Aurélie Hennebique
- Centre National de Référence des Francisella, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France
| | - Sandrine Boisset
- Centre National de Référence des Francisella, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France
| | - Max Maurin
- Centre National de Référence des Francisella, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France
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Faber M, Heuner K, Jacob D, Grunow R. Tularemia in Germany-A Re-emerging Zoonosis. Front Cell Infect Microbiol 2018; 8:40. [PMID: 29503812 PMCID: PMC5821074 DOI: 10.3389/fcimb.2018.00040] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/31/2018] [Indexed: 11/17/2022] Open
Abstract
Tularemia, also known as “rabbit fever,” is a zoonosis caused by the facultative intracellular, gram-negative bacterium Francisella tularensis. Infection occurs through contact with infected animals (often hares), arthropod vectors (such as ticks or deer flies), inhalation of contaminated dust or through contaminated food and water. In this review, we would like to provide an overview of the current epidemiological situation in Germany using published studies and case reports, an analysis of recent surveillance data and our own experience from the laboratory diagnostics, and investigation of cases. While in Germany tularemia is a rarely reported disease, there is evidence of recent re-emergence. We also describe some peculiarities that were observed in Germany, such as a broad genetic diversity, and a recently discovered new genus of Francisella and protracted or severe clinical courses of infections with the subspecies holarctica. Because tularemia is a zoonosis, we also touch upon the situation in the animal reservoir and one-health aspects of this disease. Apparently, many pieces of the puzzle need to be found and put into place before the complex interaction between wildlife, the environment and humans are fully understood. Funding for investigations into rare diseases is scarce. Therefore, combining efforts in several countries in the framework of international projects may be necessary to advance further our understanding of this serious but also scientifically interesting disease.
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Affiliation(s)
- Mirko Faber
- Gastrointestinal Infections, Zoonoses and Tropical Infections (Division 35), Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group, Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany.,Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
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Gozel MG, Engin A, Altuntas EE, Salk İ, Kaya A, Celik C, Dokmetas I, Bakir M, Elaldi N. Evaluation of clinical and laboratory findings of pediatric and adult patients with oropharyngeal tularemia in Turkey: a combination of surgical drainage and antibiotic therapy increases treatment success. Jpn J Infect Dis 2015; 67:295-9. [PMID: 25056077 DOI: 10.7883/yoken.67.295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We analyzed the clinical and laboratory findings of both pediatric and adult patients with oropharyngeal tularemia. We also compared the therapeutic outcomes of patients who underwent surgical drainage of lymph nodes early or late during antibiotic therapy. A total of 68 patients with oropharyngeal tularemia, including 26 children and 42 adults, were enrolled in this study. The average duration between symptom onset and hospital admission was 20.8 days (4-60 days) in the pediatric group and 32.6 days (4-90 days) in the adult group (P = 0.009). The most frequently observed clinical symptoms were sore throat (100% and 100%), fever (96.2% and 90.5%), tonsillitis (69.2% and 78.6%), and rash (15.4% and 11.9%) in the pediatric and adult groups, respectively. However, the frequencies of erythema, tenderness, and fluctuant of enlarged lymph nodes were significantly higher in the adult group than in the pediatric group (P = 0.005, P = 0.029, and P = 0.041, respectively). Treatment failure was observed in 2 (7.7%) pediatric patients and 4 (9.5%) adult patients, for a total of 6 (8.8%) treatment failures in the study group. Similar clinical findings and treatment outcomes were observed in both groups. We concluded that a combination of surgical drainage and antibiotic therapy increases treatment success for patients diagnosed with oropharyngeal tularemia.
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Affiliation(s)
- Mustafa Gokhan Gozel
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University Faculty of Medicine
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Rimawi RH, Shah KB, Chowdhary RA, Cook PP. Hunting for tularaemia - a review of cases in North Carolina. Zoonoses Public Health 2014; 62:159-64. [PMID: 24655540 DOI: 10.1111/zph.12114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Indexed: 11/26/2022]
Abstract
Human infections with Francisella tularensis can be acquired via numerous routes, including ingestion, inhalation, arthropod bite or direct contact with infected animals. Since 1991, there have been 25 reported cases of tularaemia in North Carolina, most of which were associated with rabbit hunting or cat bites. We present two adults cases of pulmonary and oropharyngeal tularaemia and review the reported cases since 1991-2013. We also present the fifth case of pulmonary empyema. While cavitary pneumonias are primarily treated with drainage, we illustrate a case of cavitary pneumonia associated with tularaemia successfully treated with oral ciprofloxacin after drainage. Tularaemia should be considered in patients with a perplexing radiographic image, animal exposure and lack of response to conventional empiric broad-spectrum antibiotics. Even in serious cases of pneumonic tularaemia, fluoroquinolones may provide a suitable alternative to aminoglycosides.
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Affiliation(s)
- R H Rimawi
- Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine, East Carolina University, Greenville, NC, USA; Division of Pulmonary and Critical Care Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Thomas RJ. Particle size and pathogenicity in the respiratory tract. Virulence 2013; 4:847-58. [PMID: 24225380 PMCID: PMC3925716 DOI: 10.4161/viru.27172] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/08/2013] [Accepted: 11/12/2013] [Indexed: 12/13/2022] Open
Abstract
Particle size dictates where aerosolized pathogens deposit in the respiratory tract, thereafter the pathogens potential to cause disease is influenced by tissue tropism, clearance kinetics and the host immunological response. This interplay brings pathogens into contact with a range of tissues spanning the respiratory tract and associated anatomical structures. In animal models, differential deposition within the respiratory tract influences infection kinetics for numerous select agents. Greater numbers of pathogens are required to infect the upper (URT) compared with the lower respiratory tract (LRT), and in comparison the URT infections are protracted with reduced mortality. Pathogenesis in the URT is characterized by infection of the URT lymphoid tissues, cervical lymphadenopathy and septicemia, closely resembling reported human infections of the URT. The olfactory, gastrointestinal, and ophthalmic systems are also infected in a pathogen-dependent manner. The relevant literature is reviewed with respect to particle size and infection of the URT in animal models and humans.
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Yıldırım S, Turhan V, Karadenizli A, Önem Y, Karagöz E, Eroğlu C, Çiftçi F. Tuberculosis or tularemia? A molecular study in cervical lymphadenitis. Int J Infect Dis 2013; 18:47-51. [PMID: 24239221 DOI: 10.1016/j.ijid.2013.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/15/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Over the last two to three decades there has been a marked decrease in certain bacterial infections in Turkey. One of them is tuberculosis. Of note, statistics published by the Turkish Ministry of Health (MoH) show decreasing pulmonary tuberculosis (PTB), but on the other hand, increasing extrapulmonary tuberculosis (EPTB). The most common form of EPTB is tuberculous cervical lymphadenitis (TCL). The increase in the number of TCL cases despite the decline in cases of PTB is seen as a paradoxical issue. In contrast there has been an increase in the number of oropharyngeal tularemia cases in the last decade in Turkey. The aim of this study was to draw attention to the importance of differentiating between TCL and tularemia lymphadenitis, because these diseases may have a similar histopathological appearance. METHODS Thirty-two cases diagnosed as TCL were identified from the archives of a pathology laboratory (Patomer Pathology Laboratory, Bursa, Turkey). PCR tests for Francisella tularensis and Mycobacterium tuberculosis were carried out on the paraffin tissue blocks of these cases. At the same time, statistical data on PTB and EPTB for the period 1996-2010 were retrieved from the MoH and reviewed. Statistics related to tularemia, which has been diagnosed since 1988 and has been increasing in the last 10 years, were obtained from the Department of Zoonoses of the MoH. RESULTS Six out of 32 (19%) cases who had previously been diagnosed with 'casseifying granulomatous lymphadenitis consistent with tuberculosis' were found to be positive for tularemia by PCR test of the cervical lymph nodes. CONCLUSIONS Oropharyngeal tularemia should be kept in mind in the differential diagnosis of cervical lymphadenitis in widespread geographic regions of the Northern Hemisphere, including the Asian continent. In particular, if granulomatous inflammation with necrosis is seen histopathologically, tularemia should be excluded before making the diagnosis of TCL.
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Affiliation(s)
- Sükrü Yıldırım
- Pathology Laboratory, Bursa Military Hospital, Bursa, Turkey
| | - Vedat Turhan
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.
| | - Aynur Karadenizli
- Department of Medical Microbiology, Kocaeli University, Kocaeli, Turkey
| | - Yalçın Önem
- Department of Internal Medicine, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Ergenekon Karagöz
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Cafer Eroğlu
- Department of Infectious Diseases and Clinical Microbiology, Samsun 19 Mayıs University, Samsun, Turkey
| | - Faruk Çiftçi
- Department of Tuberculosis and Chest Diseases, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
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Tularaemia presenting as parapharyngeal abscess: case presentation. The Journal of Laryngology & Otology 2012; 126:535-7. [DOI: 10.1017/s0022215112000096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:We report an extremely rare case of the oropharyngeal form of tularaemia, causing a parapharyngeal abscess.Case report:A 48-year-old woman presented with fever, sore throat, breathing difficulty and a right-sided neck swelling. This mass had previously been treated with penicillin without response, and had already been surgically drained once in another hospital. On physical examination, the tonsils were exudative and hypertrophic and the pharynx was hyperaemic. A fluctuant, 4 × 4 cm mass was seen on endoscopic examination, originating from the left parapharyngeal area and protruding towards the pyriform sinus, and partly obstructing the airway. Microagglutination test antibody titres for Francisella tularensis were positive (1/1280). The patient healed completely after definitive drainage of the abscess and antimicrobial therapy for 14 days (streptomycin, 2 × 1 g intramuscularly).Conclusion:Tularaemia should be considered in the differential diagnosis of patients presenting with tonsillopharyngitis, cervical lymphadenitis and parapharyngeal abscess who do not respond to treatment with penicillin, even if they do not live in an endemic region.
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Tularemia: a rare cause of neck mass, evaluation of 33 patients. Eur Arch Otorhinolaryngol 2011; 268:1699-704. [DOI: 10.1007/s00405-011-1722-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
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Djordjevic-Spasic M, Potkonjak A, Kostic V, Lako B, Spasic Z. Oropharyngeal tularemia in father and son after consumption of under-cooked rabbit meat. ACTA ACUST UNITED AC 2011; 43:977-81. [DOI: 10.3109/00365548.2011.592988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Potz-Biedermann C, Schwendemann L, Schröppel K, Sönnichsen K, Schmidt D, Schaller M. Ulceroglandular tularemia. J Dtsch Dermatol Ges 2011; 9:806-8. [PMID: 21501382 DOI: 10.1111/j.1610-0387.2011.07670.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An increasing number of patients with the zoonosis tularemia have been reported in the last few years in Europe. Tularemia can be divided into different forms depending on its appearance. Tularemia must be considered in the differential diagnosis of diseases that present with an ulcer and regional lymphadenopathy. The diagnosis can be confirmed by culturing Francisella tularensis. With effective antibiotic intervention, the prognosis is favorable. Typically tularemia develops after outdoor activities; it is generally transferred by blood-sucking arthropods from infected wild animals to humans.
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Ugur KS, Ark N, Kilic S, Kurtaran H, Kosehan D, Gunduz M. Three cases of oropharyngeal tularemia in Turkey. Auris Nasus Larynx 2011; 38:532-7. [PMID: 21236608 DOI: 10.1016/j.anl.2010.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to attract our colleagues' attention to the oropharyngeal tularemia, which has been an infrequently diagnosed disease in otolaryngology clinics also becoming widespread in Turkey. METHODS A retrospective review of database of 3 patients was performed to find patients with Tularemia. The medical files, treatment charts, serological and PCR findings and radiological (magnetic resonance imaging), histopathological records of these patients were reviewed. RESULTS The study group consisted of 3 oropharyngeal tularemia patients. All of them presented with tonsillopharyngitis and cervical lymphadenitis and all were resistant to beta lactam or cephalosporin group antibiotics. Two patients had magnetic resonance imaging findings. All patients had positive serological tests. Strongly positive serological tests led to the diagnosis of tularemia. All patients had positive PCR and direct fluorescent antibody (DFA) test. All patients responded to systemic streptomycin treatment. CONCLUSION In the daily practice of an otolaryngologist, it is not usual to diagnose a patient with oropharyngeal tularemia. Tularemia should be considered in the differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical lymphadenopathy not responding to beta lactam antibiotics as a result of the rising number of tularemia outbreaks outside the classic endemic areas.
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Affiliation(s)
- Kadriye Serife Ugur
- Department of Otolaryngology, Head & Neck Surgery, Fatih University, Faculty of Medicine, Ankara, Turkey
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