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

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.