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Treatment-failure tularemia in children
Arzu Karlı1, Gülnar Şensoy1, Şule Paksu2
1Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Insights
Pediatric tularemia treatment can be challenging. This study found that while initial antibiotic therapies sometimes fail, oral ciprofloxacin often leads to recovery in non-responsive cases of Francisella tularensis infection.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Microbiology
Background:
- Tularemia, caused by *Francisella tularensis*, presents diagnostic and therapeutic challenges.
- Oropharyngeal tularemia is a significant concern in pediatric populations.
Purpose of the Study:
- To evaluate treatment strategies for pediatric tularemia patients resistant to initial medical interventions.
- To identify factors contributing to treatment failure in pediatric tularemia.
Main Methods:
- Retrospective, single-center study of 19 pediatric oropharyngeal tularemia cases.
- Analysis of medical treatment responses, including antibiotics (streptomycin, gentamicin, ciprofloxacin, doxycycline) and surgical interventions.
Main Results:
- Initial antibiotic treatments (streptomycin, gentamicin, doxycycline) were often ineffective.
- Oral ciprofloxacin was successful in achieving recovery in non-responsive patients.
- Surgical interventions like incision and drainage or mass excision were necessary for 58% of patients with abscesses.
Conclusions:
- Delayed diagnosis and the development of suppurating lymph nodes are key factors in tularemia treatment failure.
- Effective and timely treatment, potentially involving ciprofloxacin or surgical management, is crucial for pediatric tularemia.
Purpose:
Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment.
Methods:
A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included.
Results:
Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment.
Conclusion:
The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.
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