Clinical manifestations of 16 oropharyngeal tularemia patients: Experience of a referral hospital in the city of Konya, Turkey

Abstract

Aim: In recent years, tularemia's importance has been reemerging in Turkey. However, the majority of tularemia cases were reported in the northern cities of Turkey. In this study, we report 16 oropharyngeal tularemia patients living in rural areas of the city of Konya, which is located in the southern zone of the Central Anatolia Region of Turkey. Materials and methods: Sixteen patients (12 males, 4 females; mean age: 33.7 years, range: 10-73 years) were included in this study. All patients were admitted to our clinic for the evaluation of intractable cervical mass lesions. The diagnosis of tularemia was made after exclusion of other possible causes of the neck masses and the presence of a positive tularemia agglutination test. Each patient was treated with streptomycin and doxycycline for at least 3 weeks. Results: All patients suffered oropharyngeal stiffness. There were neck mass and tonsillitis on the same side in 2 patients, neck mass and acute pharyngitis in 3 patients, and only swelling in the neck region in 11 patients. One of the patients with tonsillitis had common maculopapular skin rashes with fever. Thirteen patients had mass at level 2 zones, 11 patients had mass on the right side of the neck, and 5 patients had mass on the left side of the neck. The right parotid gland was involved in 1 patient. Nine patients were successfully treated with only antimicrobial agents. Lymph node excision was performed in 6 patients, and parotidectomy was performed in 1 patient. Conclusion: This is the second series of tularemia from the city of Konya in Turkey. Tularemia should be considered in the differential diagnosis of patients with intractable neck mass, because early diagnosis and treatment may prevent surgical interventions. © TÜBİTAK.