Tularemia in Children: Evaluation of 22 Cases

Objective:Tularemia is a highly contagious bacterial zoonotic disease deriving from gram-negative Francisella tularensis. The disease is difficult for clinicians, and due to its rarity, a high level of suspicion is required for diagnosis. The purpose of the present study was to retrospectively examine the clinical characteristics, laboratory findings, and responses to treatment of pediatric tularemia cases treated in our clinic. Material and Methods: Pediatric tularemia cases were included in this retrospective study. The medical records of patients with confirmed diagnoses were examined, and demographic characteristics such as age and gender, presentation symptoms, and risky contact status were recorded. Factors such as living in rural areas, working in agriculture and animal husbandry, similar disease among friends and family, and drinking water sources were examined. Patients' physical and laboratory findings, and medical and surgical treatment results were recorded. Results:Twenty-two pediatric cases were included in the study, 15 (68.2%) boys and seven (31.8%) girls. The patients were aged mean 12 +/- 2.8 (min max; 3-15 years), and 15 (68.2%) were diagnosed in the fall. The mean time from onset of symptoms to presentation to our hospital was 31.8 +/- 20.8 days (min-max; 7-90 days). The most common presentation symptoms were fatigue (54.5%), fever (45.5%), sore throat (%45.5), lack of appetite (40.9%), and abdominal pain-diarrhea (31.8%). Cervical lymphadenopathy (LAP) was determined in all patients at physical examination. Surgical treatment was applied to 18 (81.8%) patients who did not respond to medical treatment [abscess drainage to 14 (63.6%) and LAP excision to four (18.2%)]. Conclusion: Tularemia must be considered in terms of early diagnosis and treatment in children presenting with cervical LAP in endemic regions and not responding to 0-lactam and/or macrolide group antibiotics.