title: An outbreak of oropharyngeal tularemia with cervical adenopathy predominantly in the left side.
abstract: OBJECTIVE
  We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey.
  
  
  METHODS
  Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests.
  
  
  RESULTS
  Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days.
  
  
  CONCLUSIONS
  This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the left side were found, which had not been previously reported.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Abant Izzet Baysal University, Duzce Medical School, Duzce, Turkey. isencan@dtip.edu.tr
authors.forename: Irfan
authors.initials: I
authors.lastname: Sencan
authors.forename: Idris
authors.initials: I
authors.lastname: Sahin
authors.forename: Demet
authors.initials: D
authors.lastname: Kaya
authors.forename: Sukru
authors.initials: S
authors.lastname: Oksuz
authors.forename: Davut
authors.initials: D
authors.lastname: Ozdemir
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009960:Oropharynx; D014406:Tularemia / Q000453:epidemiology* / Q000473:pathology*; D014421:Turkey / Q000453:epidemiology; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water