Epidemiological and clinical characteristics and management of oropharyngeal tularemia outbreak

Authors: MUSTAFA ÖNDER UZUN, KERAMETTİN YANIK, MÜGE ERDEM, UĞUR KOSTAKOĞLU, GÜRDAL YILMAZ, YELİZ TANRIVERDİ ÇAYCI

Abstract: Background/aim: The purpose of this study was to determine the epidemiological and clinical characteristics of patients diagnosed with tularemia and the effectiveness of the administered treatments. Materials and methods: Patients treated in our hospital between January 2009 and March 2011 and diagnosed with tularemia were evaluated retrospectively. Patients' epidemiological and clinical characteristics, administered treatments, and posttreatment findings were recorded on patient monitoring forms. Results: At anamnesis, 29% of patients used water from wells and 71% used water from the network supply; moreover, 48.4% had a history of contact with animals and 87.1% a history of lethargy. At physical examination, 96.8% had a mass in the neck and 90.3% had fever. Gentamycin + doxycycline therapy was administered to 45.2% of patients, while levofloxacin, gentamycin, and streptomycin were used for the other patients. After treatment, neck masses persisted in 48.4% of patients and complaints of lethargy and fever in 6.5%. Treatment of these patients was initiated once tularemia had been diagnosed, as test results were announced about 3 weeks later. Lymphadenopathy excision was performed on 19.4% of patients in whom neck mass persisted. Conclusion: Appropriate empiric antibiotherapy should be commenced in patients presenting with neck mass, fever, and lethargy in regions with tularemia epidemics.

Keywords: Francisella tularensis, tularemia, epidemic

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