Correspondence Address:
Oguz Karabay
Sakarya University, Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 54000, Sakarya
Turkey

Full Text

Tularemia is caused by the bacterium Francisella tularensis, which is a gram-negative, aerobic, immobile, intracellular bacterium. F. tularensis is survive in macrophages for a long time. [1] It is a zoonotic bacterial disease of the northern hemisphere. It is extremely virulent for humans and simply spreads by aerosol or water and it can cause outbreaks. [2]

A 59-year-old male patient was admitted to the hospital with complaints of high fever, neck swelling, and throat pain. Physical examination revealed fever (38.6°C temperature) and painful 4 cm4 cm sized lymphadenopathy in the right sub-mandibular area [Figure 1]a and b. Despite the sulbactam-ampicillin treatment there was no improvement in the patient's complaints.{Figure 1}

The patient lived in a rural area and he used to hunt. History of mouse infestation of his dwelling was present. The patient's serum was positive for tularemia at 1/640 titer by microagglutination test. F. tularensis real time Taqman polymerase chain reaction (PCR) test was found positive from the aspirated sample [Figure 2]. Treatment with gentamicin was started and he responded to the treatment.{Figure 2}

Clinical manifestations of tularemia may range from an asymptomatic illness to septic shock and death. F. tularensis can be transmitted through the respiratory system, direct contact with animals, skin abrasions, scratches and contaminated drinking water. [3] Contamination is usually during the winter months. F. tularensis is resistant to macrolides, co-trimoxazole, and beta-lactam antibiotics (i.e., penicillin, cephalosporins). Tularemia should be considered, If the patients with cervical lymphadenitis do not improve despite the use of these antibiotics In these cases, aminoglycosides, tetracycline or quinolones should be used. Tularemia has a mortality rate of less than 1%, and leaves a lifelong immunity. [4]

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