title: Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia.
abstract: Tularemia outbreaks have occurred in various regions of Turkey in recent years. In this study, clinical (145 patients) and laboratory (97 patients) features of patients with oropharyngeal tularemia were evaluated during the tularemia outbreak in the district of Gölcük in Kocaeli, Turkey. We analyzed the risk factors for therapeutic failure and prolonged recovery time, and compared the efficacy of three antibiotic groups, namely aminoglycoside, tetracycline and quinolone. The most common physical sign and laboratory findings in patients were lymphadenopathy (LAP) and increased erythrocyte sedimentation rate, respectively. Treatment failure was observed in 55 of the 145 (38%) patients during one-year follow-up and the most successful results were obtained in the quinolone group. It was determined that antimicrobial therapy initiated 14 days after onset of symptoms was a statistically significiant risk factor, reducing the success rate (p=0.0001, OR=13.10, 95% CI=5.69-30.15) and prolonging the recovery period (p=0.001, OR=3.23, 95% CI=1.63-6.40) in oropharyngeal tularemia cases. These results suggest that antimicrobial treatment should be started early, and quinolones such as moxifloxacin and ciprofloxacin seem to be new alternatives in the treatment of oropharyngeal tularemia.
authors.affiliation: Department of Clinical Bacteriology and Infectious Diseases, Medical Faculty, Kocaeli University, Kocaeli, Turkey. drmelihameric@gmail.com
authors.forename: Meliha
authors.initials: M
authors.lastname: Meric
authors.forename: Ayse
authors.initials: A
authors.lastname: Willke
authors.forename: Enrst-Jurgen
authors.initials: EJ
authors.lastname: Finke
authors.forename: Roland
authors.initials: R
authors.lastname: Grunow
authors.forename: Murat
authors.initials: M
authors.lastname: Sayan
authors.forename: Sarper
authors.initials: S
authors.lastname: Erdogan
authors.forename: Suna
authors.initials: S
authors.lastname: Gedikoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008206:Lymphatic Diseases / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D015363:Quinolones / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014406:Tularemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones