title: Evaluation of clinical and sonographic features in 55 children with tularemia.
abstract: OBJECTIVE
  The aim of this study was to determine the clinical characteristics and sonographic features of lymphadenopathy (LAP) and to evaluate the treatment modalities and treatment outcomes in children with tularemia.
  
  
  METHODS
  Demographic characteristics, ultrasonographic and physical examination findings, and treatment outcomes in 55 tularemia patients (24 male and 31 female) with a mean age of 10.8 ± 4.0 years were analyzed retrospectively. Lymph node necrosis was classified in three stages based on ultrasound findings-stage 1, cortical microabscesses; stage 2, cortical and medullar abscesses; stage 3, total necrosis of the lymph node.
  
  
  RESULTS
  In total, 50 (90%) of the patients had oropharyngeal, four (8%) had glandular, and one (2%) had oculoglandular tularemia. The most common symptoms were sore throat (67%) and fever (64%). LAP was the most frequently (100%) observed sign. Abscess formation was noted in 36 (65%) patients, of which seven (19%) were sonographically classified as stage 1, 20 (55%) as stage 2, and nine (26%) as stage 3. There was a statistically significant correlation between delayed treatment and stage of abscess formation in lymph nodes (p<0.05). Treatment failure was observed in 24 (44%) patients. There was no significant correlation between treatment regimen and treatment failure (p>0.05). In all, nine (16%) of the patients did not respond to medical treatment, and surgical intervention was required.
  
  
  CONCLUSIONS
  Tularemia should be considered in the differential diagnosis of children presenting with unexplained fever, sore throat, and cervical LAP in endemic areas. Sonographic findings may be useful in the evaluation and staging of this infection.
authors: 1 Pediatric Infectious Diseases Department, Dr. Sami Ulus Maternity and Children's Research and Training Hospital , Anakara, Turkey .
authors: Fatma
authors: F
authors: Oz
authors: Ayse
authors: A
authors: Eksioglu
authors: Gonul
authors: G
authors: Tanır
authors: Gulsum
authors: G
authors: Bayhan
authors: Özge
authors: Ö
authors: Metin
authors: Turkan Aydın
authors: TA
authors: Teke
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005604:Francisella tularensis / Q000276:immunology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure; D014406:Tularemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014421:Turkey; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents
keywords: Differential diagnosis; Francisella tularensis; Lymphoadenopathy; Pediatric patients; Tularemia; Ultrasonography