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Tularemia is becoming increasingly important as a differential diagnosis in suspicious neck masses: experience in Turkey

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Neck mass can be an initial finding of many diseases at any age. The differential diagnosis is broad and includes inflammatory, congenital and neoplastic lesions. We retrospectively analyzed charts of the 145 patients with neck mass and without known primary malignancy whose diagnoses were confirmed with histopathologic and serologic examination between July 2003 and July 2008. Twenty-six patients (17.9%) were diagnosed with tularemia. Before 2004, serologic testing for tularemia was not a part of our workup for patients with an inflammatory neck mass. Otolaryngologists should be familiar with head and neck manifestations of tularemia and consider the disease in the differential diagnosis of neck masses. The tularemia outbreak in central Black Sea region, Turkey in 2004 changed our approach to a patient presenting with neck mass.

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References

  1. Tracy TF Jr, Muratore CS (2007) Management of common head and neck masses. Semin Pediatr Surg 16:3–13. doi:10.1053/j.sempedsurg.2006.10.002

    Article  PubMed  Google Scholar 

  2. Ahmadi SA, Tavakoli H, Samadi N (2006) Neck mass as the first presentation of testicular choriocarcinoma. Eur Arch Otorhinolaryngol 263(1):290–292. doi:10.1007/s00405-005-0982-6

    Article  PubMed  Google Scholar 

  3. Görür K, Talas DU, Ozcan C (2005) An unusual presentation of neck dermoid cyst. Eur Arch Otorhinolaryngol 262(4):353–355. doi:10.1007/s00405-004-0813-1

    Article  PubMed  Google Scholar 

  4. Osma U, Cureoglu S, Yaldiz M et al (2001) Castleman’s disease (giant lymph node hyperplasia) of the neck: a case report. Eur Arch Otorhinolaryngol 258(1):42–44. doi:10.1007/s004050000292

    Article  PubMed  CAS  Google Scholar 

  5. Leblebicioglu H, Esen S, Turan D et al (2008) Outbreak of tularemia: a case–control study and environmental investigation in Turkey. Int J Infect Dis 12:265–269. doi:10.1016/j.ijid.2007.06.013

    Article  PubMed  Google Scholar 

  6. Atmaca S, Leblebicioglu H, Ünal R et al (2005) Samsun ve çevresinde görülen tularemi olguları. KBB-Forum 4(4):171–172

    Google Scholar 

  7. Helvaci S, Gedikoglu S, Akalin H et al (2000) Tularemia in Bursa, Turkey: 205 cases in 10 years. Eur J Epidemiol 16:271–276. doi:10.1023/A:1007610724801

    Article  PubMed  CAS  Google Scholar 

  8. Rinaldo A, Bradley P, Ferlito A (2004) Tularemia in otolaryngology: a forgotten but not gone disease and a possible sign of bio-terrorism. J Laryngol Otol 118:257–259

    PubMed  Google Scholar 

  9. Nordahl SHG, Hoel T, Scheel O et al (1993) Tularemia: a differential diagnosis in oto-rhino-laryngology. J Laryngol Otol 107:127–129. doi:10.1017/S002221510012239X

    Article  PubMed  CAS  Google Scholar 

  10. Willis PI, Gedosh EA, Nichols DR (1982) Head and neck manifestations of tularemia. Laryngoscope 92:770–773. doi:10.1288/00005537-198207000-00012

    Article  Google Scholar 

  11. Luotonen L, Tapiainen T, Kallioinen M et al (2002) Tularemia of the middle ear. Pediatr Infect Dis J 21:264–265. doi:10.1097/00006454-200203000-00024

    Article  PubMed  Google Scholar 

  12. Mair IW, Natvig K, Johannessen TA (1973) Otolaryngological manifestations of tularemia. Arch Otolaryngol 98:156–158

    PubMed  CAS  Google Scholar 

  13. Umlas SL, Jaramillo D (1990) Massive adenopathy in oropharyngeal tularemia; C.T. demonstration. Pediatr Radiol 20:483–484. doi:10.1007/BF02075217

    Article  PubMed  CAS  Google Scholar 

  14. Markowitz LE, Hynes NA, de la Cruz P et al (1985) Tick-born tularemia. An outbreak of lymphadenopathy in children. JAMA 254:2922–2925. doi:10.1001/jama.254.20.2922

    Article  PubMed  CAS  Google Scholar 

  15. Collision PJ, Adams B (2003) Glandular tularemia in a Native American child. Ear Nose Throat J 82:851–854

    Google Scholar 

  16. Kandemir B, Erayman I, Bitirgen M et al (2007) Tularemia presenting with tonsillopharyngitis and cervical lymphadenitis: report of two cases. Scand J Infect Dis 39:620–622. doi:10.1080/00365540601105814

    Article  PubMed  Google Scholar 

  17. Robson CD (2000) Imaging of granulomatous lesions of the neck in children. Radiol Clin North Am 38:969–977. doi:10.1016/S0033-8389(05)70215-3

    Article  PubMed  CAS  Google Scholar 

  18. Karabay O, Yilmaz F, Gurcan S et al (2007) Medical image. Tularaemic cervical lymphadenopathy. NZ Med J 120(1248):U2403

    Google Scholar 

  19. Arikan OK, Koç C, Bozdogan O (2003) Tularemia presenting as tonsillopharyngitis and cervical lymphadenitis: a case report and review of the literature. Eur Arch Otorhinolaryngol 260:298–300. doi:10.1007/s00405-002-0565-8

    Article  PubMed  Google Scholar 

  20. Luotonen J, Syrjala H, Jokinen K et al (1986) Tularemia in otolaryngologic practice. An analysis of 127 cases. Arch Otolaryngol Head Neck Surg 112:77–80

    PubMed  CAS  Google Scholar 

  21. Stupak HD, Scheuller MC, Schindler DN et al (2003) Tularemia of the head and neck: a possible sign of bioterrorism. Ear Nose Throat J 82:263–265

    PubMed  Google Scholar 

  22. Tunga U, Bodrumlu E, Acikgoz A et al (2007) A case of tularemia presenting as a dental abscess: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:e33–e35. doi:10.1016/j.tripleo.2006.06.047

    Article  PubMed  Google Scholar 

  23. Evans ME, Gregory DW, Schaffner W et al (1985) Tularemia: a 30 year experience with 88 cases. Medicine (Baltimore) 64:251–269. doi:10.1097/00005792-198507000-00006

    CAS  Google Scholar 

  24. Moxness MH, Bergh K (2006) Tularaemia as a differential diagnosis in tumour colli. Tidsskr Nor Laegeforen 126:1055–1057

    PubMed  Google Scholar 

  25. Schroder KE, Elverland HH, Mair IW et al (1979) Granulomatous cervical lymphadenitis. J Otolaryngol 8:127–131

    PubMed  CAS  Google Scholar 

  26. Castellote A, Vazquez E, Vera J et al (1999) Cervicothoracic lesions in infants and children. Radiographics 19:583–600

    PubMed  CAS  Google Scholar 

  27. Alonso Ovies A, Redondo Gonzalez LM, Lobo Valentin P et al (2000) Tularemia in the differential diagnosis of cervical lymph node enlargement. An outbreak of tularemia in Castilla-Leon, Spain. Acta Otorrinolaringol Esp 51:62–67

    PubMed  CAS  Google Scholar 

  28. Benlyazid A, Lescanne E, Borderon JC et al (1997) Cervicofacial manifestations of tularemia. Apropos of a familial case. Ann Otolaryngol Chir Cervicofac 114:80–83

    PubMed  CAS  Google Scholar 

  29. Boui M, Errami E (2007) Tularemia outbreak in Kosovo. Ann Dermatol Venereol 134:839–842. doi:10.1016/S0151-9638(07)92827-6

    Article  PubMed  CAS  Google Scholar 

  30. Meriç M, Sayan M, Willke A et al (2008) A small water-borne tularemia outbreak. Mikrobiyol Bul 42:49–59

    PubMed  Google Scholar 

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Correspondence to Sinan Atmaca.

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Atmaca, S., Bayraktar, C., Çengel, S. et al. Tularemia is becoming increasingly important as a differential diagnosis in suspicious neck masses: experience in Turkey. Eur Arch Otorhinolaryngol 266, 1595–1598 (2009). https://doi.org/10.1007/s00405-008-0891-6

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  • DOI: https://doi.org/10.1007/s00405-008-0891-6

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