Tularaemia - one of the Less Common Causes of Nodular Syndrome and Pulmonary Affectionin Childhood

Overview

The glandular form of tularaemia is a rare cause of nodular syndrome in childhood. Recently the disease isencountered increasingly in adults but also in children. In recent years we treated at the Clinic a single patient in1995, in autumn 1998 there were already four patients within 3 months. Unilateral lymphadenitis was in threeinstances cervical, twice axillary. In all patients the enlarged nodes were extirpated but the histological examinationdid not reveal an unequivocal diagnosis. Only evidence of a raised agglutinin titre against tularaemia was decisive.Concurrent antibiotic treatment led in all children to cure. Contraction of the infection by injury or a tick wasfound only in three instances, in two children penetration of the infection through intact skin is assumed. Thenodular form of tularaemia must be taken into account in the differential diagnosis in addition to tuberculosis,avian mycobacteriosis and other uncommon conditions.Even less common in tularaemia is affection of the lungs. It was observed during the same period in three boysaged 12 - 16 years. The pulmonary finding is characterized by tumourous hilar adenopathy and thus it is importantto rule out in particular tuberculosis or a tumour. The course is protracted, lasting several weeks to months, anddoxycycline and azithromycin proved the best therapy. The diagnosis is confirmed by serological evidence ofagglutinins. In the acute stage their titre may attain high levels. The disease is usually contracted by inhalation.

Key words:
tularaemia, nodular syndrome, pulmonary affection, hilar adenopathy, paediatrics