An 11-year-old boy presented with a 4-week history of progressive painless unilateral cervical lymph node swelling. The patient was otherwise symptom-free. The other family members, including three siblings, exhibited no symptoms whatsoever. There was no history of travel or contact with animals, with the exception of a healthy parrot kept indoors and cared for by the father. Outpatient treatment with amoxicillin/clavulanic acid had already been carried out for 1 week. The only laboratory finding of note was an ESR of 19 mm/h. Imaging demonstrated suppurative lymphadenitis along the vascular nerve bundle without erosion of the structures. The differential diagnosis included, in addition to atypical mycobacteria, Bartonella, Toxoplasma, Chlamydia psittaci, and Francisella. Polymerase chain reaction performed on the surgically collected specimen/partially debrided material revealed Francisella tularensis ssp. holarctica. The disease, which laboratories are obliged to report, is rare in Germany, with 59 transmissions in 2020, although the trend has been increasing over the past decade. Due to the ubiquitous presence of the pathogen in the environment, there are multiple routes of infection. Local findings completely resolved with a 10-day course of ciprofloxacin treatment. In more complex cases, competence and treatment centers for high consequence infectious diseases should become involved.
Interessenkonflikt: Die Autorin und die Autoren erklären, dass kein Interessenkonflikt besteht.
Translated from the orignal German by Christine Rye.
Cite this as: Vogel B, Blume C, Brangenberg R: Ulceroglandular tularemia in children.
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