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. 2018 Feb;61(2):49-52.
doi: 10.3345/kjp.2018.61.2.49. Epub 2018 Feb 28.

Treatment-failure tularemia in children

Arzu Karlı  1 , Gülnar Şensoy  1 , Şule Paksu  2 , Muhammet Furkan Korkmaz  2 , Ömer Ertuğrul  2 , Rıfat Karlı  3
Affiliations

Treatment-failure tularemia in children

Arzu Karlı et al. Korean J Pediatr. 2018 Feb.

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.

Keywords: Surgical procedures; Treatment failure; Tularemia.

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Conflict of interest statement

Conflicts of interest: No potential conflict of interest relevant to this article was reported.

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