Cervical lymphadenitis: tuberculosis or tularaemia?

Area of Science:

• Infectious Diseases
• Microbiology
• Immunology

Background:

• Tuberculosis cervical lymphadenitis (TCL) and oropharyngeal tularaemia (OT) present with overlapping clinical and pathological features.
• Differentiating these conditions is crucial for accurate diagnosis and treatment, especially in regions where both are endemic.

Purpose of the Study:

• To determine the frequency of tularaemia antibodies in patients diagnosed with TCL in Turkey.
• To assess the diagnostic value of tularaemia serology in TCL patients.

Main Methods:

• A cross-sectional study involving 1170 TCL patients and 596 healthy controls from Turkey (2008-2011).
• Sera were tested for Francisella tularensis antibodies using microagglutination technique (MAT).
• Brucella antibodies were tested in tularaemia-seropositive sera to evaluate cross-reactivity.

Main Results:

• Tularaemia antibodies (MAT titre ≥1:80) were detected in 6.75% of TCL patients versus 0.33% of controls (p < 0.01).
• Considering any antibody titre, 8.2% of TCL patients and 0.67% of controls were seropositive (p < 0.001).
• This study is the first to report a significant prevalence of positive tularaemia serology in diagnosed TCL cases.

Conclusions:

• Tularaemia serology should be considered in the differential diagnosis of suspected TCL, particularly in tularaemia-endemic regions.
• The findings highlight the importance of investigating tularaemia in patients presenting with symptoms consistent with TCL.