title: Evaluation of tularaemia courses: a multicentre study from Turkey.
abstract: In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.
authors: Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
authors: H
authors: H
authors: Erdem
authors: D
authors: D
authors: Ozturk-Engin
authors: M
authors: M
authors: Yesilyurt
authors: O
authors: O
authors: Karabay
authors: N
authors: N
authors: Elaldi
authors: G
authors: G
authors: Celebi
authors: N
authors: N
authors: Korkmaz
authors: T
authors: T
authors: Guven
authors: S
authors: S
authors: Sumer
authors: N
authors: N
authors: Tulek
authors: O
authors: O
authors: Ural
authors: G
authors: G
authors: Yilmaz
authors: S
authors: S
authors: Erdinc
authors: S
authors: S
authors: Nayman-Alpat
authors: E
authors: E
authors: Sehmen
authors: C
authors: C
authors: Kader
authors: N
authors: N
authors: Sari
authors: A
authors: A
authors: Engin
authors: G
authors: G
authors: Cicek-Senturk
authors: G
authors: G
authors: Ertem-Tuncer
authors: G
authors: G
authors: Gulen
authors: F
authors: F
authors: Duygu
authors: A
authors: A
authors: Ogutlu
authors: E
authors: E
authors: Ayaslioglu
authors: A
authors: A
authors: Karadenizli
authors: M
authors: M
authors: Meric
authors: M
authors: M
authors: Ulug
authors: C
authors: C
authors: Ataman-Hatipoglu
authors: F
authors: F
authors: Sirmatel
authors: S
authors: S
authors: Cesur
authors: S
authors: S
authors: Comoglu
authors: A
authors: A
authors: Kadanali
authors: A
authors: A
authors: Karakas
authors: A
authors: A
authors: Asan
authors: I
authors: I
authors: Gonen
authors: Y
authors: Y
authors: Kurtoglu-Gul
authors: N
authors: N
authors: Altin
authors: S
authors: S
authors: Ozkanli
authors: F
authors: F
authors: Yilmaz-Karadag
authors: M
authors: M
authors: Cabalak
authors: S
authors: S
authors: Gencer
authors: A
authors: A
authors: Umut Pekok
authors: D
authors: D
authors: Yildirim
authors: D
authors: D
authors: Seyman
authors: B
authors: B
authors: Teker
authors: H
authors: H
authors: Yilmaz
authors: K
authors: K
authors: Yasar
authors: I
authors: I
authors: Inanc Balkan
authors: H
authors: H
authors: Turan
authors: M
authors: M
authors: Uguz
authors: S
authors: S
authors: Kilic
authors: Y
authors: Y
authors: Akkoyunlu
authors: S
authors: S
authors: Kaya
authors: A
authors: A
authors: Erdem
authors: A
authors: A
authors: Inan
authors: Y
authors: Y
authors: Cag
authors: S
authors: S
authors: Bolukcu
authors: A
authors: A
authors: Ulu-Kilic
authors: N
authors: N
authors: Ozgunes
authors: L
authors: L
authors: Gorenek
authors: A
authors: A
authors: Batirel
authors: C
authors: C
authors: Agalar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014406:Tularemia / Q000188:drug therapy / Q000473:pathology*; D014421:Turkey; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical course; histopathology; surgery; therapy; tularaemia; ultrasound