The Turkish Journal of Pediatrics 2012 , Vol 54 , Num 2
Tularemia in Children: Evaluation of Clinical, Laboratory and Therapeutic Features of 27 Tularemia Cases
Departments of 1Pediatrics, 2Medical Biochemistry and 3Otorhinolaryngology, Cumhuriyet University Faculty of Medicine, Sivas, and 4Department of Medical Microbiology, Sivas State Hospital, Sivas, Turkey Tularemia is a zoonotic disease caused by Francisella tularensis. We aimed to explicate the clinical and laboratory findings of 27 consecutive tularemia patients who were included into the study. The average duration between onset of symptoms and diagnosis was 19.1±7.3 days. Sore throat (100%), fever (93%) and myalgia (100%) were the most frequently observed symptoms, while lymphadenopathy (100%), pharyngeal hyperemia (85%), tonsillitis (74%), and rash (7%) were the most frequently observed physical findings. Treatment failed in 6 patients: 1/13 streptomycin- (changed to doxycycline + streptomycin), 1/7 ciprofloxacin- (changed to streptomycin), and 4/7 gentamicin- (changed to streptomycin) receiving patients who had longer duration to treatment (26.5±2.9 days) than the 21 successfully treated cases (17.0±6.8 days). Tularemia should to be taken into account in the differential diagnosis in cases having tonsillopharyngitis and cervical lymphadenopathy without response to beta lactam/macrolide-group antibiotics in rural areas. We believe that streptomycin should be the first-line antibiotic in the treatment of pediatric tularemia cases, but it should be supported by comprehensive studies with larger patient series. Keywords : Francisella tularensis, outbreak, tularemia, children.
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