[Tularemia with long-lasting alteration of cellular immunity: A case report]

A case of a 31-year-old female with the oroglandular form of tularemia, most likely acquired by consuming vegetables from her own garden, is presented. Initial treatment of a condition presenting as acute tonsillitis did not lead to regression of cervical lymphadenopathy, prompting serological testing and subsequent diagnosis of tularemia. The patient was then treated with a combination of ciprofloxacin and gentamicin; however, due to progression of cervical lymph node involvement with central colliquation, surgical extirpation of the affected lymph node package was indicated. Following the procedure, the patient's clinical condition evolved without further complications, although wound healing was prolonged. During hospitalization, flow cytometry was used for the first time to determine the relative proportion of CD3+/CD4-/CD8- T-lymphocytes, which was initially 56.9%. This proportion remained elevated at 11.8% even three years after the acute illness. These findings illustrate the potential diagnostic value of the elevation of this T-cell subpopulation in the early phase of tularemia, even before seroconversion, and point to a long-term alteration of the immune system induced by Francisella tularensis. Keywords: tularemia, case report, cellular immunity, T-lymphocytes.