title: Three cases of oropharyngeal tularemia in Turkey.
abstract: OBJECTIVE
  We aimed to attract our colleagues' attention to the oropharyngeal tularemia, which has been an infrequently diagnosed disease in otolaryngology clinics also becoming widespread in Turkey.
  
  
  METHODS
  A retrospective review of database of 3 patients was performed to find patients with Tularemia. The medical files, treatment charts, serological and PCR findings and radiological (magnetic resonance imaging), histopathological records of these patients were reviewed.
  
  
  RESULTS
  The study group consisted of 3 oropharyngeal tularemia patients. All of them presented with tonsillopharyngitis and cervical lymphadenitis and all were resistant to beta lactam or cephalosporin group antibiotics. Two patients had magnetic resonance imaging findings. All patients had positive serological tests. Strongly positive serological tests led to the diagnosis of tularemia. All patients had positive PCR and direct fluorescent antibody (DFA) test. All patients responded to systemic streptomycin treatment.
  
  
  CONCLUSIONS
  In the daily practice of an otolaryngologist, it is not usual to diagnose a patient with oropharyngeal tularemia. Tularemia should be considered in the differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical lymphadenopathy not responding to beta lactam antibiotics as a result of the rising number of tularemia outbreaks outside the classic endemic areas.
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Fatih University, Faculty of Medicine, Ankara, Turkey.
authors.forename: Kadriye Serife
authors.initials: KS
authors.lastname: Ugur
authors.forename: Nebil
authors.initials: N
authors.lastname: Ark
authors.forename: Selcuk
authors.initials: S
authors.lastname: Kilic
authors.forename: Hanifi
authors.initials: H
authors.lastname: Kurtaran
authors.forename: Dilek
authors.initials: D
authors.lastname: Kosehan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gunduz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology; D008199:Lymphadenitis / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck; D009960:Oropharynx; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis* / Q000188:drug therapy; D010612:Pharyngitis / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012698:Serologic Tests; D013307:Streptomycin / Q000627:therapeutic use; D014069:Tonsillitis / Q000382:microbiology; D014406:Tularemia / Q000175:diagnosis*; D014421:Turkey; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D013307:Streptomycin