Delayed Diagnosis of Tularemia in a Nonendemic Area: A Report of Three Cases

Güleç, Güliz Uyar

doi:10.5152/kd.2019.45

Cited by 3 publications

(3 citation statements)

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“…If its treatment is delayed, it causes morbidity, mortality and loss of workforce [3]. Especially living in rural areas, dealing with agriculture and consuming spring water are among the risk factors [10][11][12]. In our study, living in a rural area and being engaged in agriculture are among the possible risk factors.…”

Section: Discussionmentioning

confidence: 78%

“…In periods when the number of tularemia cases was high (it reached its peak level in 2011), the duration of diagnosis was shortened due to the large number of studies carried out by the Ministry of Health to increase awareness. However, there are delays in diagnosis, especially in regions where tularemia is not endemic, patients have to use unnecessary antibiotics due to misdiagnosis [ 7 , 11 , 14 , 15 ]. In our study, patients used beta-lactam group antibiotics most frequently before the diagnosis of tularemia.…”

Section: Discussionmentioning

confidence: 99%

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Tularemia in the Differential Diagnosis of Lymphadenitis: A Retrospective Analysis of 16 Cases

Binay¹,

Barkay²,

Karakeçili³

2023

Cureus

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Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis , a gram-negative, facultative, intracellular coccobacillus. It can occur in different clinical forms, and the most common form in our country (Turkey) is the oropharyngeal form. Unfortunately, the diagnosis of lymphadenitis caused by tularemia is delayed unless it is suspected, especially in sporadic cases. Our aim is to remind clinicians to have tularemia among differentials of lymphadenitis. Methods: In this study, the clinical and laboratory findings of 16 tularemia patients between 2011 and 2021 were evaluated retrospectively. Results: The mean age of the 16 patients included in the study was 39 years, and 62.5% were female. The patients were diagnosed with tularemia on the average 31st day of their complaints. The rate of use of beta-lactam group antibiotics before diagnosis was 74%. About 81.25% of the patients were engaged in animal husbandry/farming, and living in rural areas (93.75%) and farming (81.25%) were the most common possible risk factors. The patients were admitted to the hospital with the most common complaints of enlarged lymph nodes (100%), fatigue (62.5%) and loss of appetite (56.25%). All patients had lymphadenopathy, and the most common location of lymphadenopathy was the cervical region (81.25%). Moxifloxacin (56.25%) was used most frequently in the treatment of tularemia, and surgical drainage was performed for 31% of the patients. Conclusion: The diagnosis of tularemia is often delayed unless clinical suspicion is high. Delayed diagnosis may lead to unnecessary frequent use of antibiotics, especially beta-lactam group antibiotics. As the diagnosis is delayed, since lymph node suppuration is common, surgical intervention may be required. This situation can cause extra burden for both patients and the health system. It may be beneficial to organize trainings to increase awareness among physicians and society in order to make the diagnosis early.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Tularemia in the Differential Diagnosis of Lymphadenitis: A Retrospective Analysis of 16 Cases

Binay¹,

Barkay²,

Karakeçili³

2023

Cureus

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“…Most of the cases are reported from Sweden, Finland, and Turkey. In Turkey, tularemia outbreaks have been reported in Marmara, Thrace, Central Anatolia, and Western Black Sea regions (23). When the tularemia cases were examined in Turkey, it was seen that the cases peaked (n: 2.151) in 2011 (24).…”

Section: Discussionmentioning

confidence: 99%

Investigation of Francisella tularensis Seroprevalence and Determination of Risk Factors for Tularemia among Hunters in Northern Cyprus

Güler,

Güvenir,

Korbay

et al. 2024

JAD

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Background: Tularemia is a zoonotic disease (reservoir is usually rodents) caused by Francisella tularensis, especially seen in the northern hemisphere. Hunters are in the risk group for this disease. In this study, it was aimed to determine the seroprevalence of tularemia among hunters and determine the risk factors of tularemia in our country. Methods: The Turkish Republic of Northern Cyprus (TRNC) is divided into four regions (Nicosia, Kyrenia, Famagusta/Trikomo, and Morphou/Lefka) and 100 volunteer hunters randomly selected from these regions were included in our study. Tube agglutination test (TAT) and F. tularensis IgG and IgM (ELISA method) were applied in all sera. All hunters were filled with a pre-prepared questionnaire to determine risk factors for tularemia. Results: TAT positivity was found in 11%. While F. tularensis ELISA IgG positivity was 17%, IgM positivity was not found in any hunters. Hunters with positive F. tularensis ELISA IgG test (17%) were accepted as seropositive in terms of tularemia. There was no statistically significant difference between the mean age of IgG-positive and negative hunters (p= 0.915). Of the 86 hunters who kept at least one hunting dog in their garden, 15 (17.4%) were IgG-positive. There was no significant relationship between feeding hunting dogs and tularemia (p= 0.561). Conclusion: Our study showed that the seroprevalence of tularemia was high (17%) among hunters, who are considered a risk group, in our country. We think that more epidemiological research should be done on tularemia infection and it should not be overlooked in the clinic.

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Antalya İlinin Tularemi Açısından Değerlendirilmesi

MIZRAKÇI¹,

Demiray²

2022

Black Sea Journal of Health Science

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Türkiye tularemi açısından endemik ülkeler arasında bulunmaktadır. Zoonotik bir hastalık olan tularemi, ülkemizde zaman zaman salgınlara ve sporadik vakalara neden olan önemli bir halk sağlığı sorunudur. Sıklıkla bulaş yolu, enfekte/kontamine hayvan teması, kontamine suların tüketilmesi veya vektörler aracılıklı olabilir. Hastalık en sık boyunda lenfadenopati ile kendini göstermekte ve çoğu zaman yanlış tanı almaktadır. Hastalığın tanısında serolojik yöntemlerin gerekli olması nedeniyle akla gelmemesi durumunda hastalık tanısının konulmasında sorun oluşturmaktadır. Hastalığın ülkemizdeki bilinen en büyük salgını Antalya ilinde olmuştur. Mevsimsel değişiklikler ve artan göçler gibi birçok değişken hastalık epidemiyolojisinin değişmesine neden olmuştur. Biz de bu derleme çalışmasında, Antalya ilinin tulareminin açısından değerlendirmesini yapmayı amaçladık.

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Delayed Diagnosis of Tularemia in a Nonendemic Area: A Report of Three Cases

Cited by 3 publications

References 0 publications

Tularemia in the Differential Diagnosis of Lymphadenitis: A Retrospective Analysis of 16 Cases

Tularemia in the Differential Diagnosis of Lymphadenitis: A Retrospective Analysis of 16 Cases

Investigation of Francisella tularensis Seroprevalence and Determination of Risk Factors for Tularemia among Hunters in Northern Cyprus

Antalya İlinin Tularemi Açısından Değerlendirilmesi

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