Tularemia con afectación faríngea y ganglionar cervical

Abstract

Introduction: Tularemia is a zoonosis produced by the bacterium Francisella tularensis, which is found mainly in rabbits and other animals and sometimes free in the soil or in contaminated waters. It is typically spread by ticks although it can also be acquired by contact with animal products, water or contaminated food or by aerosolization of the bacteria. In geographical areas with a high percentage of rural population in contact with animals, it´s still a disease to be considered in the differential diagnosis of adenopathic syndromes.

Clinical case: A 45-year-old man with no history of interest who was admitted to the Emergency Department due to right odynophagia without fever and a right laterocervical mass. The examination revealed ulceration and several aphthae at the level of the right amygdala, as well as cervical adenopathy in level II right about 5 cm in size; blood test within normality. Treatment with amoxicillin-clavulanic acid and anti-inflammatories was established, but after a few days the patient consulted again for lack of improvement. A neck CT with contrast was requested, showing an suppurative cervical lymphadenitis in right area II of 3 cm in size. Serology was positive for tularemia. We started treatment with intravenous Levofloxacin for 5 days and then oral for 10 days, with good response. Follow-up at 3 months showed an asymptomatic patient, negativization of the serology and complete resolution of cervical adenopathy.

Discussion: Seven clinical forms of tularemia are distinguished, being the ulceroganglionar responsible for 75% of the cases: it´s consists in skin or mucosal lesion and adenopathies larger than 1 cm. It is common to find suppurative adenopathies, being able to spontaneous fistulizatin to skin. In 25% of patients, a pure oropharyngeal form or pharyngitis associated with lymphadenopathy appears, due to the ingestion of water or food contaminated with the bacteria. F. tularensis is resistant to beta-lactams and, generally, to macrolides, that´s why quinolones are the treatment of choice in most cases. Patients with very large adenopathies may require drainage or complete excision of the ganglion with its capsule.