Tularemia: retrospective review of 10 years' experience in Arkansas

The purpose of this study is to review all cases of tularemia, a tick-borne illness, among inpatients at Arkansas Children's Hospital (ACH) from 1996-2006 to discuss clinical presentation, diagnosis and treatment. Records of the Infectious Disease Section were reviewed to identify cases of suspected or proven tularemia.

Seventeen patients presented with ulceroglandular tularemia and thirteen with glandular disease. Most patients had been ill for 10-14 days prior to admission and were evaluated at least once by another physician. Serology was positive in 77% of patients, including several positive on convalescent testing alone. Most patients responded well to treatment with gentamicin.

This series emphasizes the importance of tularemia as an early consideration among children with fever and lymphadenopathy in Arkansas. Convalescent serology is an important tool, as many patients will remain seronegative early in illness. Gentamicin remains effective treatment and should be considered first-line therapy for suspected tularemia.