An Important Disease for Our Country in Lymphadenopathy Etiology: Tularemia

INTRODUCTION: In our country, tularemia was first reported in 1936, and today it is mostly seen in Marmara, West-Central Black Sea, and Central Anatolia regions; and in rural areas where sanitation of water is insufficient. In this study, clinical and laboratory findings of patients who were followed up with a diagnosis of tularemia were evaluated retrospectively. METHODS: Microbiologically or serologically confirmed tularemia patients admitted to our hospital between January 2010 and January 2019 were included in the study. Demographic characteristics, clinical and laboratory findings of the patients were obtained from case report forms, and follow-up charts of the patients. RESULTS: Mean age of the patients was 43 years, and the majority (66%) of the patients were female. Fifty-two percent of the patients were using well water. The most common complaints on admission were neck swelling (92%), weakness (90%), fever (76%), and sore throat (72%). The average time from the onset of symptoms to admission to the hospital was 22 days. While lymphadenopathy (94%) and conjunctivitis (24%) were the most common clinical findings, 1(2%) patient had splenomegaly. Cervical lymph nodes were involved in most of the patients (65%) presenting with lymphadenopathy. Diagnosis of patients was confirmed by microagglutination test and antibody titers ranged between 1/160 and 1/1280. Francisella tularensis polymerase chain reaction positivity was shown in 6(12%) patients' aspiration specimen, while the microorganism was grown in culture in 2(4%) patients. DISCUSSION AND CONCLUSION: In our country, tularemia should be kept in mind as a differential diagnosis, especially in patients who present with swelling in the neck, sore throat, high fever, and does not respond to beta-lactam group antibiotic treatment.