title: Oropharyngeal tularemia--a differential diagnosis of tonsillopharyngitis and cervical lymphadenitis.
abstract: Francisella tularensis, the causative agent of tularemia, has been recognized as a human and zoonotic pathogen for almost 100 years. The increasing number of tularemia outbreaks in regions of Europe outside the classic endemic areas in recent years has prompted renewed interest in this rare infectious disease. We report on a case of oropharyngeal tularemia in an 18-year-old girl from Bavaria (Germany) who presented with tonsillopharyngitis and cervical lymphadenitis. Strongly positive serological tests and PCR detection of F. tularensis subsp. holarctica in lymph node tissue led to the diagnosis of tularemia. After long-term treatment with doxycycline, partly in combination with ciprofloxacin, the patient recovered completely. Clinical presentation, diagnostics, treatment and recent epidemiological aspects of tularemia in Europe are discussed in this case report and review of the literature.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Germany. julia_dlugaiczyk@yahoo.de
authors.forename: Julia
authors.initials: J
authors.lastname: Dlugaiczyk
authors.forename: Thomas
authors.initials: T
authors.lastname: Harrer
authors.forename: Jochen
authors.initials: J
authors.lastname: Zwerina
authors.forename: Maximilian
authors.initials: M
authors.lastname: Traxdorf
authors.forename: Stephan
authors.initials: S
authors.lastname: Schwarz
authors.forename: Wolf
authors.initials: W
authors.lastname: Splettstoesser
authors.forename: Walter
authors.initials: W
authors.lastname: Geissdörfer
authors.forename: Christoph
authors.initials: C
authors.lastname: Schoerner
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009059:Mouth Diseases / Q000175:diagnosis*; D009333:Neck; D010608:Pharyngeal Diseases / Q000175:diagnosis*; D010612:Pharyngitis / Q000150:complications / Q000175:diagnosis; D014069:Tonsillitis / Q000150:complications / Q000175:diagnosis; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis; D014406:Tularemia / Q000175:diagnosis*; D055815:Young Adult