Tularemia – a rare differential diagnosis of infections in the ENT region

A 31-year-old man presented with fever, right cervical lymph node swelling, and odynophagia. Right peritonsillar abscess was followed by tonsillectomy á chaud. Under i.v. antibiotic therapy, the right lymph node swelling did not regress. A melted lymph node was identified in the neck by CT, which was surgically removed. Francisella tularensis was detected in this case.

In another case, a 31-year-old woman presented with painful lymph node swelling and melted lymph node conglomerates cervical bilaterally, depicted by CT. Diagnostic lymph node extirpation failed to detect the causative agent. Serological testing for rare pathogens performed in the presence of persistent symptoms finally revealed the presence of antibodies against Francisella tularensis.

Francisella tularensis is a gram-negative bacterium whose reservoir is wild animals, especially hares. The incidence is 0.01/100,000 and transmission occurs by direct contact with infected animals, contaminated water or dust, and consumption of meat containing the pathogen. Clinical manifestations include ulcers of the skin and swelling of the lymph nodes, as well as manifestations in the pharynx or eyes. The invasive form with involvement of internal organs is often lethal. The diagnosis is confirmed by pathogen cultivation or serological antibody detection. Treatment is performed using tetracyclines or macrolides.

Tularaemia is a rare but dangerous disease. The nonspecific clinical appearance, the rarity and the difficult pathogen detection are a challenge for diagnosis and therapy. The history of exposure to wild animals can be a decisive factor in establishing the diagnosis.

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Artikel online veröffentlicht:
24. Mai 2022