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Korean J Pediatr 2018 February;61(2) :49-52.
Published online 2018 February 15.       
Treatment-failure tularemia in children
Arzu Karl1, Gülnar Sensoy1, Sule Paksu2, Muhammet Furkan Korkmaz2, Ömer Ertugrul2, Rfat Karl3
1Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
2Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
3Departments of Otorhinolaryngology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
Corresponding Author: Muhammet Furkan Korkmaz ,Tel: +90-362-312-1919-4040, Fax: +90-362-4576041, Email:
Copyright © 2018 by The Korean Pediatric Society
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 32.1517.8 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.
Keywords: Tularemia | Treatment failure | Surgical procedures
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