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Oropharyngeal tularemia – a differential diagnosis of tonsillopharyngitis and cervical lymphadenitis

Oropharyngeale Tularämie als Differentialdiagnose der Tonsillopharyngitis und zervikalen Lymphknotenschwellung

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Zusammenfassung

Francisella tularensis, der Auslöser der Tularämie, ist seit fast 100 Jahren als Krankheitserreger bei Mensch und Tier bekannt. Durch die steigende Zahl von Krankheitsausbrüchen in verschiedenen Regionen Europas außerhalb klassischer Endemiegebiete hat das Interesse an dieser seltenen Infektionskrankheit in den letzten Jahren wieder stark zugenommen. Wir berichten über einen Fall von oropharyngealer Tularämie bei einem 18-jährigen Mädchen aus Bayern (Deutschland) mit Tonsillopharyngitis und zervikaler Lymphknotenschwellung. Die Diagnose einer Tularämie wurde durch hochpositive Serologie und den Nachweis von F. tularensis subspecies holarctica in Lymphknotengewebe mittels PCR gestellt. Nach einer Langzeitbehandlung mit Doxycyclin, vorübergehend auch in Kombination mit Ciprofloxacin, erholte sich die Patientin vollständig. Anhand des vorgestellten Falles und einer Literaturübersicht werden klinisches Bild, Diagnostik, Therapie und aktuelle epidemiologische Entwicklungen der Tularämie in Europa diskutiert.

Summary

Francisella tularensis, the causative agent of tularemia, has been recognized as a human and zoonotic pathogen for almost 100 years. The increasing number of tularemia outbreaks in regions of Europe outside the classic endemic areas in recent years has prompted renewed interest in this rare infectious disease. We report on a case of oropharyngeal tularemia in an 18-year-old girl from Bavaria (Germany) who presented with tonsillopharyngitis and cervical lymphadenitis. Strongly positive serological tests and PCR detection of F. tularensis subsp. holarctica in lymph node tissue led to the diagnosis of tularemia. After long-term treatment with doxycycline, partly in combination with ciprofloxacin, the patient recovered completely. Clinical presentation, diagnostics, treatment and recent epidemiological aspects of tularemia in Europe are discussed in this case report and review of the literature.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Germany

    Julia Dlugaiczyk & Maximilian Traxdorf

  2. Department for Internal Medicine III and Institute for Clinical Immunology, University Hospital Erlangen, Germany

    Thomas Harrer & Jochen Zwerina

  3. Institute of Pathology, University Hospital Erlangen, Germany

    Stephan Schwarz

  4. Microbiology Institute – Clinical Microbiology, Immunology and Hygiene, University Hospital Erlangen, Germany

    Walter Geißdörfer & Christoph Schoerner

  5. Bundeswehr Institute of Microbiology, Munich, Germany

    Wolf Splettstoesser

  6. Present address: Department of Otorhinolaryngology, Saarland University Hospital, Homburg/Saar, Germany

    Julia Dlugaiczyk

Authors
  1. Julia Dlugaiczyk
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  2. Thomas Harrer
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  3. Jochen Zwerina
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  4. Maximilian Traxdorf
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  5. Stephan Schwarz
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  6. Wolf Splettstoesser
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  7. Walter Geißdörfer
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  8. Christoph Schoerner
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Corresponding author

Correspondence to Julia Dlugaiczyk.

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Dlugaiczyk, J., Harrer, T., Zwerina, J. et al. Oropharyngeal tularemia – a differential diagnosis of tonsillopharyngitis and cervical lymphadenitis. Wien Klin Wochenschr 122, 110–114 (2010). https://doi.org/10.1007/s00508-009-1274-8

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  • DOI: https://doi.org/10.1007/s00508-009-1274-8

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