title: Dermatologic manifestations of tularemia: a study of 151 cases in the mid-Anatolian region of Turkey.
abstract: BACKGROUND
  Tularemia is a serious and potentially life-threatening zoonosis caused by Francisella tularensis, a highly infective, gram-negative coccobacillus. Although there are plenty of case reports and studies of tularemia outbreaks, the literature is lacking in reports on dermatologic manifestations of the disease.
  
  
  OBJECTIVE
  This study aimed to identify skin manifestations in clinical forms of tularemia.
  
  
  METHODS
  A total of 151 patients diagnosed with tularemia at Çankırı State Hospital, Çankırı, Turkey, were retrospectively examined. Dermatologic data for these patients were assessed.
  
  
  RESULTS
  The most frequent clinical manifestation of tularemia was the glandular form (49.7%), followed by the oropharyngeal, ulceroglandular, and oculoglandular forms (39.1, 6.0, and 5.3%, respectively). Physical manifestations were observed in 64.5% of females and 56.9% of males. Lymphadenopathy and tonsillitis were the most frequent physical findings and were noted in 57.6 and 25.2% of patients, respectively. Erythema multiforme was found in 17 patients (11.3%), most of whom presented with the oropharyngeal and glandular forms, and was followed by ulcer (6.0%), urticaria (3.3%), erythema nodosum (2.6%), and cellulitis (0.7%). However, it should be noted that this study was retrospective and that its patient sample demonstrated four of the six clinical forms of tularemia.
  
  
  CONCLUSIONS
  Patients with the oropharyngeal form of tularemia had statistically significantly more physical findings than those with other clinical forms of the disease (P < 0.001). There were statistically more skin findings in the ulceroglandular form (P < 0.001). There was no statistical correlation between serum antibody titers and cutaneous findings (P = 0.585). Although the literature reports that skin lesions are observed more frequently in women than in men, we did not find any statistically significant difference between the sexes in any type of skin lesion.
authors.affiliation: Department of Dermatology, Hitit University Faculy of Medicine, Çankırı State Hospital, Çankırı, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Şenel
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Satılmış
authors.forename: Bilal
authors.initials: B
authors.lastname: Acar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004892:Erythema Multiforme / Q000382:microbiology; D004893:Erythema Nodosum / Q000382:microbiology; D005128:Eye Diseases / Q000382:microbiology; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009960:Oropharynx; D017192:Skin Diseases, Bacterial / Q000382:microbiology*; D012883:Skin Ulcer / Q000382:microbiology; D014406:Tularemia / Q000150:complications* / Q000188:drug therapy; D014421:Turkey; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents