Tularemia in Children, Turkey, September 2009–November 2012 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Tularemia in Children, Turkey, September 2009–November 2012 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 1—January 2015

Synopsis

Tularemia in Children, Turkey, September 2009–November 2012

On This Page

• Material and Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2
• Figure 3

Tables

• Table 1
• Table 2
• Table 3

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Hasan Tezer, Aslınur Ozkaya-Parlakay , Hakan Aykan, Mustafa Erkocoglu, Belgin Gülhan, Ahmet Demir, Saliha Kanik-Yuksek, Anil Tapisiz, Meltem Polat, Soner Kara, Ilker Devrim, and Selcuk Kilic

Author affiliations: Gazi University School of Medicine, Ankara, Turkey (H. Tezer, A. Tapisiz, M. Polat, S. Kara);Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara (A. Ozkaya-Parlakay, H. Aykan, M. Erkocoglu, B. Gülhan, A. Demir, S. Kanik-Yuksek); Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey (I. Devrim); Public Health Institution of Turkey, Ankara (S. Kilic)

Suggested citation for this article

Abstract

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.

Tularemia, caused by Francisella tularensis, is a potentially fatal, multisystemic disease in humans. Tularemia occurs throughout most of the Northern Hemisphere, and the number of cases is increasing in various parts of Europe, especially in the Balkans, Turkey, and Scandinavian countries. There are 4 recognized subspecies of F. tularensis, which differ in their pathogenicity and geographic distribution: tularensis (type A), holarctica (type B),novicida, and mediasiatica. Among them, subspecies tularensis and holarctica are of particular clinical and epidemiologic relevance (1–4). Although the highly virulent subspecies tularensis is restricted almost exclusively to North America, subspecies holarctica is found in Europe, Asia, and North America and represents the most common subspecies involved in human and animal infection (4).

The clinical forms of tularemia are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory, and typhoidal (1). Each form somehow reflects the mode of transmission. The clinical picture and severity of the disease in humans vary considerably depending on the route of infection, the virulence of the causative organism, and the immune status of the host. The ulceroglandular form has been reported as the most prevalent clinical form of the disease in northern Europe, whereas the oropharyngeal form has been most commonly reported in Turkey, Bulgaria, and Kosovo and is attributed to the consumption of contaminated water and food (5–10).

Tularemia is endemic to Turkey, and most cases are reported to occur in late summer or early autumn (10). Various studies on clinical course, treatment, and treatment failure in elderly patients are available in the literature (7,10–12). However, the clinical course of tularemia in children is not well known, and cases in children are often misdiagnosed. Our aim was to demonstrate the clinical features and outcomes for children with tularemia.

Dr Tezer is a physician at the Gazi University School of Medicine hospital. His research interest is zoonotic diseases, especially tularemia and Crimean-Congo hemorrhagic fever.

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Figures

• Figure 1. Diagnosis of tularemia for 100 children, by patient age group and sex, Ankara, Turkey, September 2009–November 2012.
• Figure 2. Diagnosis of tularemia for 100 children, by month, Ankara, Turkey, September 2009–November 2012.
• Figure 3. Data regarding outcome for 100 children with tularemia, Ankara, Turkey, September 2009–November 2012.

Tables

• Table 1. Clinical characteristics of 100 children with tularemia, Ankara, Turkey, September 2009–November 2012
• Table 2. Outcomes for 100 children with tularemia, Ankara, Turkey, September 2009–November 2012
• Table 3. Results of regression analysis for variables predicting treatment outcomes for 100 children with tularemia, Ankara, Turkey, September 2009–November 2012

Suggested citation for this article: Tezer H, Ozkaya-Parlakay A, Aykan H, Erkocoglu M, Gülhan B, Demir A, et al. Tularemia in children, Turkey, September 2009–November 2012. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.131127

DOI: 10.3201/eid2101.131127