title: [Tularemia: study of 27 patients].
abstract: BACKGROUND
  There has been an important tularemia outbreak recently in Spain, which has prompted a high epidemiological interest. Our objective was to describe the series of tularemia cases with emphasis being paid on clinical characteristics and evolution of the disease.
  
  
  METHODS
  We describe 27 cases of tularemia studied clinically and epidemiologically (survey of the Health Territorial Service at Burgos). Two cases were seen in December 2000 as isolated forms, while the rest of cases accumulated in form of outbreak between September 1997 and the first months of 1998. We performed a follow-up of patients including a questionnaire (via phone) to assess relapses or disease's consequences and complications.
  
  
  RESULTS
  48% patients were males and patients' mean age was 52 years (27 to 72). 96% patients had handled hares in relation to hunting practices. Main symptoms were weariness (92%), general discomfort (88%), lymph node enlargement (85%) and fever (81%). Skin lesions were seen in 77% patients. A delay in the initial diagnosis was found in 40% cases. Main complications included: lymph node suppuration (25%) and persistent weariness (18%). In patients with and without a diagnostic delay, 62/21% had lymph node enlargement longer than 1 month, 46/7% had adenopathy suppuration (p < 0.05) and 31/7% had persistent weariness, respectively.
  
  
  CONCLUSIONS
  Clinical and epidemiological features of tularemia are similar to those described in previous reports. The disease behaved in a uniform and benign form without serious or evolutive complications. Diagnostic delay was the main added morbidity factor.
authors.affiliation: Sección de Medicina Interna. Servicio Territorial de Sanidad. Hospital General Yagüe. Burgos. España.
authors.forename: Santiago
authors.initials: S
authors.lastname: González Quijada
authors.forename: Mayte
authors.initials: M
authors.lastname: Rubio Díaz
authors.forename: José Luis
authors.initials: JL
authors.lastname: Yánez Ortega
authors.forename: Isabel
authors.initials: I
authors.lastname: Carramiñana Martínez
authors.forename: Eva
authors.initials: E
authors.lastname: Ojeda Fernández
authors.forename: Javier
authors.initials: J
authors.lastname: Lozano García
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002391:Catchment Area, Health; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014406:Tularemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents