Clinical management of treatment failure in patients with oropharyngeal tularemia: A retrospective evaluation

Tularemia is a zoonotic disease caused by Francisella tularensis pathogen. It can be transmitted via wild animals, infected water, and contaminated food. In our study, 13 patients who were admitted to our clinic with a neck mass were retrospectively evaluated for symptoms, findings, diagnosis, applied treatments, and the causes of delay in treatment. The ages of patients diagnosed with tularemia ranged from 19–70 years, with a mean age of 48.5 years. All patients resided in the countryside and all had been repeatedly administered penicillin and macrolide group antibiotics before referral to our clinic. The patients consulted our clinic with a delay of 8 to 30 days (average 11.5 days) after the onset of the first symptom. Six (46.1%) patients had deep lymphadenopathy, while lymphadenopathy in seven (53.8%) was superficial. Suppuration was observed in all adenopathies located superficially to the lymph, while skin fistulization was present in three patients. The diagnosis was made by a serum microagglutination test. Doxycycline, ciprofloxacin, and streptomycin group antibiotics were used in the treatment. No complications due to treatment were observed in the early period. In conclusion; the diagnosis of tularemia is not straightforward at the initial admission of the patients since the symptoms of tonsillopharyngitis, fever, and cervical adenopathy are similar in oropharyngeal tularemia and upper respiratory tract infections. Therefore, the antibiotics administered to the patients are not effective. In endemic regions, tularemia should be considered in the differential diagnosis in patients with tonsillopharyngitis and adenopathy in the neck.