title: Tick-related facial cellulitis caused by Francisella tularensis.
abstract: Tick-borne illnesses have diverse biological and clinical features that make recognition and appropriate treatment challenging. Arthropod-transmitted (ticks, fleas and deer flies) tularaemia remains a concern worldwide. Generally, two kinds of tularaemia manifestations, namely ulceroglandular and glandular infections, can arise from the bite of an infected arthropod vector. If the ulceroglandular or glandular form is not treated, suppuration can arise from the gland. In addition, cellulitis is rarely observed around the ulcers. In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy. Serological confirmation in the late stages of the disease suggests the importance of clinical suspicion in such rare conditions.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Arslan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Van Military Hospital, Van, Turkey 4Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Hospital, Istanbul, Turkey.
authors.forename: Ergenekon
authors.initials: E
authors.lastname: Karagöz
authors.affiliation: Department of Pathology, Istanbul Medeniyet University Hospital, Istanbul, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Zemheri
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Hospital, Istanbul, Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Vahaboglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Mert
mesh_terms: D000372:Agglutination Tests; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D002481:Cellulitis / Q000175:diagnosis / Q000209:etiology*; D003951:Diagnostic Errors; D004797:Enzyme-Linked Immunosorbent Assay; D005148:Facial Dermatoses / Q000175:diagnosis / Q000209:etiology*; D005188:False Negative Reactions; D005604:Francisella tularensis / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008193:Lyme Disease / Q000175:diagnosis; D012535:Scalp / Q000293:injuries; D012883:Skin Ulcer / Q000209:etiology / Q000382:microbiology; D064927:Tick Bites / Q000150:complications* / Q000382:microbiology; D014406:Tularemia / Q000175:diagnosis* / Q000635:transmission
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M