title: An outbreak of holarctica-type tularemia in pediatric patients.
abstract: BACKGROUND
  Holarctica-type tularemia is endemic in the Northern Hemisphere. Despite recurrent epidemics tularemia is not well known in children and the pediatric cases are often misdiagnosed.
  
  
  METHODS
  An outbreak of holarctica-type tularemia occurred in the Oulu region of Northern Finland in late summer/early August 2007. We collected prospectively data on all the cases of children diagnosed and treated for tularemia at the Department of Pediatrics, Oulu University Hospital, during the epidemic from July through September 2007.
  
  
  RESULTS
  Fifty patients were confirmed as having tularemia. All the cases appeared in a relatively small part of the Oulu region and almost all came from an area about 40 km in diameter where the annual incidence rate was high (342/100,000). Ulceroglandular tularemia was recorded in 47 of the 50 cases and secondary skin manifestations in half of the cases.
  
  
  CONCLUSIONS
  Tularemia caused by holarctica-type bacteria is a relatively mild infection, but symptoms are protracted in children and an epidemic consumes considerable health care resources.
authors.affiliation: Department of Pediatrics, University of Oulu, Oulu, Finland. ujounio@paju.oulu.fi
authors.forename: Ulla
authors.initials: U
authors.lastname: Jounio
authors.forename: Marjo
authors.initials: M
authors.lastname: Renko
authors.forename: Matti
authors.initials: M
authors.lastname: Uhari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D019353:Endemic Diseases; D005260:Female; D005387:Finland / Q000453:epidemiology; D005604:Francisella tularensis / Q000302:isolation & purification*; D005843:Geography; D006801:Humans; D007223:Infant; D008297:Male; D014406:Tularemia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology