title: Epidemiological and clinical characteristics and management of oropharyngeal tularemia outbreak.
abstract: OBJECTIVE
  The purpose of this study was to determine the epidemiological and clinical characteristics of patients diagnosed with tularemia and the effectiveness of the administered treatments.
  
  
  METHODS
  Patients treated in our hospital between January 2009 and March 2011 and diagnosed with tularemia were evaluated retrospectively. Patients' epidemiological and clinical characteristics, administered treatments, and posttreatment findings were recorded on patient monitoring forms.
  
  
  RESULTS
  At anamnesis, 29% of patients used water from wells and 71% used water from the network supply; moreover, 48.4% had a history of contact with animals and 87.1% a history of lethargy. At physical examination, 96.8% had a mass in the neck and 90.3% had fever. Gentamycin + doxycycline therapy was administered to 45.2% of patients, while levofloxacin, gentamycin, and streptomycin were used for the other patients. After treatment, neck masses persisted in 48.4% of patients and complaints of lethargy and fever in 6.5%. Treatment of these patients was initiated once tularemia had been diagnosed, as test results were announced about 3 weeks later. Lymphadenopathy excision was performed on 19.4% of patients in whom neck mass persisted.
  
  
  CONCLUSIONS
  Appropriate empiric antibiotherapy should be commenced in patients presenting with neck mass, fever, and lethargy in regions with tularemia epidemics.
authors.forename: Mustafa Önder
authors.initials: MÖ
authors.lastname: Uzun
authors.forename: Keramettin
authors.initials: K
authors.lastname: Yanik
authors.forename: Müge
authors.initials: M
authors.lastname: Erdem
authors.forename: Ugur
authors.initials: U
authors.lastname: Kostakoglu
authors.forename: Gürdal
authors.initials: G
authors.lastname: Yilmaz
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Tanriverdi Çayci
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019468:Disease Management; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004199:Disease Vectors; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D053609:Lethargy / Q000209:etiology; D064704:Levofloxacin / Q000627:therapeutic use; D008206:Lymphatic Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000473:pathology*; D013307:Streptomycin / Q000627:therapeutic use; D014406:Tularemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014421:Turkey / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D064704:Levofloxacin; D004318:Doxycycline; D013307:Streptomycin