title: [Case report: a case of tularemia with delayed diagnosis].
abstract: Tularemia is a zoonotic disease caused by Francisella tularensis. In this report, a tularemia case who was living in a non-endemic area, has been presented. A 24 years old female patient with multiple cervical lymphadenitis has been admitted to the outpatient clinic of Ankara Training and Research Hospital, Turkey. Her complaints started two months ago as signs and symptoms of an upper respiratory tract infection. As she had received non-specific treatment (amoxycillin clavulanate; 2x 1g/day) ineffective against F. tularensis, lymph nodes were suppurated. The diagnosis was made serologically, microagglutination test was positive at a titer of 1/160. The antimicrobial therapy (streptomycin; 1x1 gr im, doxycycline; 2x100 mg/day) was prolonged to four weeks, according to the clinical response of suppurated lymph nodes. It can be concluded that, early diagnosis and treatment of tularemia are important to prevent abscess formation, and patients with delayed diagnosis may benefit from prolonged therapy.
authors.affiliation: S.B. Ankara Egitim ve Araştirma Hastanesi, infeksiyon Hastaliklari ve Klinik Mikrobiyoloji, Ankara.
authors.forename: Cigdem Ataman
authors.initials: CA
authors.lastname: Hatipoglu
authors.forename: Unal
authors.initials: U
authors.lastname: Bayiz
authors.forename: Sibel Kaya
authors.initials: SK
authors.lastname: Firat
authors.forename: F Sebnem
authors.initials: FS
authors.lastname: Erdinç
authors.forename: Necla
authors.initials: N
authors.lastname: Tülek
authors.forename: Suna
authors.initials: S
authors.lastname: Gedikoglu
mesh_terms: D000328:Adult; D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000907:Antibodies, Bacterial / Q000097:blood; D004318:Doxycycline / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005604:Francisella tularensis / Q000187:drug effects / Q000276:immunology; D006801:Humans; D008199:Lymphadenitis / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000382:microbiology; D013307:Streptomycin / Q000008:administration & dosage*; D013997:Time Factors; D014406:Tularemia / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D004318:Doxycycline; D013307:Streptomycin