title: Ulceroglandular tularemia in a toddler in Germany after a mosquito bite.
abstract: BACKGROUND
  Although tularemia is a long-known disease, its significance had diminished over the last decades in Middle Europe. However, over the past years, there is new evidence suggesting that tularemia has re-emerged in Germany. In 2007, the highest number of human cases for almost 50 years has been notified. Beside typical vectors, new ways of transmission seem to gain significance. So far, mosquito bite-transmitted tularemia has only been known from Scandinavia but not from Middle Europe.
  
  
  METHODS
  We report the first case of a 1-year-old toddler from Southwestern Germany with mosquito bite-associated ulceroglandular tularaemia. The new and interesting features of this case are the young age of the patient and the unusual transmission route. The available data suggesting changes in the epidemiology for tularemia in Germany are reviewed. This is an interesting case of infantile tularemia with a very unusual transmission route, highlighting ongoing changes in the epidemiology of tularemia in Germany.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany. christof.hanke@uniklinik-freiburg.de
authors.forename: Christof A
authors.initials: CA
authors.lastname: Hanke
authors.forename: Joerg-Elard
authors.initials: JE
authors.lastname: Otten
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berner
authors.forename: Annerose
authors.initials: A
authors.lastname: Serr
authors.forename: Wolf
authors.initials: W
authors.lastname: Splettstoesser
authors.forename: Christian
authors.initials: C
authors.lastname: von Schnakenburg
mesh_terms: D000038:Abscess; D000818:Animals; D009033:Culicidae; D005858:Germany; D006801:Humans; D007223:Infant; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology; D007303:Insect Vectors; D008297:Male; D012698:Serologic Tests; D014406:Tularemia / Q000175:diagnosis / Q000473:pathology / Q000635:transmission*