Table 1.
Demographic and Clinical Characteristics of 20 Pediatric Patients With Ulceroglandular or Glandular Tularemia
| Characteristic | Finding |
|---|---|
| Female gender, No. (%) | 8 (40) |
| Median age [range], y | 9.0 [1.1–13.4] |
| Fever at illness onset | |
| No. (%) | 15 (75) |
| Median duration [range], d | 5 [1–14] |
| Rash at illness onset, No. (%) | 2 (10) |
| Tick exposure reported, No. (%) | 10 (50) |
| Ulcer/eschar at entry site, No. (%) | 14 (70)a |
| Lymph node region involved, No. (%) | |
| Cervical | 10 (50)b |
| Axillary | 2 (10)c |
| Inguinal | 8 (40) |
| Lymph node ultrasonography performed, No. (%) | 19 (95) |
| Median C-reactive protein [range], mg/L (n = 18) | 15 [1–100] |
| Median erythrocyte sedimentation rate [range], mm/h (n = 9) | 25 [11–66] |
| Microbiology—tularemia confirmed by, No. (%) | |
| Serology (n = 20) | 18 (90) |
| First ICT performed was positive (n = 18) | 13 (72)d |
| First MAT performed was positive (n = 20) | 8 (58)d |
| Culture (n = 8) | 3 (38) |
| PCR (n = 7) | 7 (100) |
| Therapy | |
| Empiric initial therapy with amoxicillin-clavulanate,e No. (%) | 16 (80) |
| Targeted antimicrobial therapy, No. (%) | |
| Ciprofloxacin | 15 (79) |
| Doxycycline | 5 (20) |
| Median duration of targeted therapy [range], d | 16 [10–28] |
| Surgical incision and drainage, No. (%) | 12 [60] |
| Hospitalization required, No. (%) | 16 [80] |
| Median duration of hospital stay [range], d | 2 [1–7] |
| Duration of follow-up [range], d | 39 [12–167] |
Abbreviations: ICT, immunochromatography; MAT, microagglutination test; PCR, polymerase chain reaction.
a
Includes 13 patients with tick-borne disease and 1 patient with a mouse bite.
b
Includes 9 patients with tick-borne disease and 1 patient with oropharyngeal disease.
c
Includes 1 patient each with tick-borne disease and with a mouse bite.
d
P = .328 (Fisher exact test, 2-sided).
e
One patient was treated with amoxicillin only.