Korean J Pediatr.  2018 Feb;61(2):49-52. 10.3345/kjp.2018.61.2.49.

Treatment-failure tularemia in children

Affiliations
  • 1Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
  • 2Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. korkmazmfurkan@gmail.com
  • 3Department of Otorhinolaryngology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.

Abstract

PURPOSE
Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment.
METHODS
A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included.
RESULTS
Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment.
CONCLUSION
The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

Keyword

Tularemia; Treatment failure; Surgical procedures

MeSH Terms

Biopsy, Fine-Needle
Child*
Ciprofloxacin
Diagnosis
Diagnosis, Differential
Doxycycline
Drainage
Francisella tularensis
Gentamicins
Humans
Lymph Nodes
Retrospective Studies
Streptomycin
Suppuration
Treatment Failure
Tularemia*
Ciprofloxacin
Doxycycline
Gentamicins
Streptomycin
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