Necat ALATAŞ, Mehmet Akif ÖZTÜRK, Ersen KOÇ, Gültekin ÖVET, Mehmet Hakan GÖRGÜLÜ, Mesut Sabri TEZER

Clinical manifestations of 16 oropharyngeal tularemia patients: experience of a referral hospital in the city of Konya, Turkey

In recent years, tularemia's importance has been reemerging in Turkey. However, the majority of tularemia cases were reported in the northern cities of Turkey. In this study, we report 16 oropharyngeal tularemia patients living in rural areas of the city of Konya, which is located in the southern zone of the Central Anatolia Region of Turkey. Materials and methods: Sixteen patients (12 males, 4 females; mean age: 33.7 years, range: 10–73 years) were included in this study. All patients were admitted to our clinic for the evaluation of intractable cervical mass lesions. The diagnosis of tularemia was made after exclusion of other possible causes of the neck masses and the presence of a positive tularemia agglutination test. Each patient was treated with streptomycin and doxycycline for at least 3 weeks. Results: All patients suffered oropharyngeal stiffness. There were neck mass and tonsillitis on the same side in 2 patients, neck mass and acute pharyngitis in 3 patients, and only swelling in the neck region in 11 patients. One of the patients with tonsillitis had common maculopapular skin rashes with fever. Thirteen patients had mass at level 2 zones, 11 patients had mass on the right side of the neck, and 5 patients had mass on the left side of the neck. The right parotid gland was involved in 1 patient. Nine patients were successfully treated with only antimicrobial agents. Lymph node excision was performed in 6 patients, and parotidectomy was performed in 1 patient. Conclusion: This is the second series of tularemia from the city of Konya in Turkey. Tularemia should be considered in the differential diagnosis of patients with intractable neck mass, because early diagnosis and treatment may prevent surgical interventions.

Anahtar Kelimeler:

Key words: Tularemia, neck mass, surgery

Clinical manifestations of 16 oropharyngeal tularemia patients: experience of a referral hospital in the city of Konya, Turkey

Keywords:

Key words: Tularemia, neck mass, surgery,

PDF

___

Ellis J, Oyston PCF, Green M, Titball R. Tularemia. Clin Microbial Rev 2002; 15: 631–46.
Akalin H, Helvaci S, Gedikoglu S. Re-emergence of tularemia in Turkey. Int J Infect Dis 2009; 13: 547–51.
Helvacı S, Gedikoğlu S, Akalın H, Oral HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol 2000; 16: 271–6. Cağlı S, Vural A, Sönmez O, Yüce I, Güney E. Tularemia: a rare cause of neck mass, evaluation of 33 patients. Eur Arch Otorhinolaryngology 2011; 268: 1699–704.
Kızıl Y, Aydil U, Cebeci S, Güzeldir OT, Inal E, Bayazıt Y. Characteristics and management of intractable neck involvement in tularemia: report of 19 patients. Eur Arch Otorhinolaryngol 2012; 269: 1285–90.
Meric M, Willke A, Finke EJ, Grunow R, Sayan M, Erdogan S et al. Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia. APMIS 2008; 116: 66–73.
Karadenizli A, Gurcan F, Kolayli F, Vahaboglu H. Outbreak of tularaemia in Golcuk, Turkey in 2005: report of 5 cases and an overview of the literature from Turkey. Scand J Infect Dis 2005; 37: 712–6.
Atmaca S, Bayraktar C, Cengel S, Koyuncu M. Tularemia is becoming increasingly important as a differential diagnosis in suspicious neck masses: experience in Turkey. Eur Arch Otorhinolaryngol 2009; 266: 1595–8.
Gürcan Ş, Eskiocak M, Varol G, Uzun C, Otkun M, Sakru N et al. Tularemia re-emerging in European part of Turkey after 60 years. Jpn J Infect Dis 2006; 59: 391–3.
Ulu Kılıç A, Kılıç S, Sencan I, Çiçek Şentürk G, Gürbüz Y, Tütüncü EE et al. A waterborne tularemia outbreak caused by Francisella tularensis subspecies halorctica in Central Anatolia region. Mikrobiyol Bul 2011; 45: 234–47.
Sencan I, Sahin I, Kaya D, Oksuz S, Ozdemir D, Karabay O. An outbreak of oropharyngeal tularemia with cervical adenopathy predominantly in the left side. Yonsei Med J 2009; 50: 50–4.
Gürcan Ş, Uzun C, Karagöl Ç, Karasalihoğlu AR, Otkun M. The first tularemia case in Thrace region of Turkey in the last 60 years. Turk J Med Sci 2006; 36: 127–9.
Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstösser W et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol 2009; 58: 112–6.
Penn RL. Francisella tularensis (tularemia). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. Elsevier Churchill Livingstone, Philadelphia; 2009. p.2927–38.