Tularemia in children, Turkey, September 2009-November 2012.
Bottom Line: The mean patient age was 10.1 ± 3.5 years (range 3-18 years), and most (63%) patients were male.Treatment response was higher and rate of relapse lower for children 5-10 years of age than for those in other age groups.Associated with treatment failure were female sex, treatment delay of ≥16 days, and use of doxycycline.
Tularemia, a zoonotic disease caused by Francisella tularensis, is found throughout most of the Northern Hemisphere. It is not well known and is often misdiagnosed in children. Our aim with this study was to evaluate the diagnosis, treatment, and prognosis for 100 children with tularemia in Turkey. The mean patient age was 10.1 ± 3.5 years (range 3-18 years), and most (63%) patients were male. The most common physical signs and laboratory findings were cervical lymphadenopathy (92%) and elevated erythrocyte sedimentation rate (89%). Treatment response was higher and rate of relapse lower for children 5-10 years of age than for those in other age groups. Associated with treatment failure were female sex, treatment delay of ≥16 days, and use of doxycycline. Tularemia is endemic to Turkey, and the number of cases has been increasing among children as well as adults.
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Mentions: Complete recovery with no complications (e.g., suppuration, need for surgical procedures, or relapse) occurred for 54 patients. However, for 8 patients with a good response, although surgery was not needed, a surgical procedure was performed to hasten the healing process. While receiving specific antimicrobial drug therapy, 9 patients experienced spontaneous suppuration. During the 12-month follow-up period after initial treatment (antimicrobial drug alone or with surgical procedures), 74 patients neither required re-treatment nor experienced relapses. A surgical procedure was performed for 43 (58.1%) of these 74 patients. The remaining 26 patients experienced relapses that required a second course of therapy (Table 2). All 26 patients received antimicrobial drugs, and 17 underwent surgical procedures. Among these 17 patients, 10 underwent a second surgical procedure. All 17 patients recovered completely and did not experience any relapses during the 12-month follow-up period. Outcome data are shown in Figure 3. Excisional biopsy specimens from 15 patients underwent histopathologic examination and revealed chronic necrotizing lymphadenitis with histiocytic infiltration and caseous necrosis.