Presentation
Authors present a case of a 75 yrs old woman treated for atypical tonsillitis with suppurative cervical lymphadenitis. [pubmed.ncbi.nlm.nih.gov]
Skip to content TO DRAIN OR NOT TO DRAIN Hillary Spangler, MD1, Erin Finn, MD2, 1UNC Hospitals, ; 2University of North Carolina, Case Presentation: A 22yo woman with no PMH presented with 2 days of right axillary swelling. [shmabstracts.org]
Respiratory symptoms, chest pain and a cough may also be present. About 35 percent of untreated naturally acquired typhoidal cases die. [luriechildrens.org]
Laura Marks, MD, PhD Laura Marks, MD, PhD, second year fellow, had a featured case in the New England Journal of Medicine of Glandular Tularemia.A 68-year-old man from Missouri presented to the primary care clinic with a history of 1 week of fever followed [infectiousdiseases.wustl.edu]
Methods: The presentation of the index case triggered an outbreak investigation involving the collection of clinical/ epidemiological data, application of tularine skin test, and laboratory confirmation of the possible cases using the tube agglutination [link.springer.com]
Immune System
- Cervical Lymphadenopathy
[…] apparent ulcer - Oculoglandular tularemia - Conjunctivitis AND - Regional lymphadenopathy - Oropharyngeal tularemia - Cervical lymphadenopathy AND at least one of the following three: - Stomatitis - Pharyngitis - Tonsillitis - Intestinal tularemia At [hpsc.ie]
Entire Body System
- Fever
Current Issue Learning/CME Learning/CME CME Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Case 39-2022: A 31-Year-Old Woman with Postpartum Abdominal Pain and Fever [nejm.org]
Typhoidal (septicemic) form: Bacteria in the bloodstream produces fevers, chills, muscle pain or tenderness, lack of energy and weight loss. The absence of an ulcer or swollen glands can make diagnosis difficult. [dph.illinois.gov]
The clinical illness was mild, consisting of fever, headache, and lymphadenopathy. All lymphadenopathy was in the head and neck area. Dermacentor variabilis ticks were identified as the vector. [jamanetwork.com]
Illness ranges from mild to life-threatening, and all forms of tularemia are accompanied by fever and swelling of the lymph glands. The most common forms are: ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic and typhoidal. [tn.gov]
- Pain
Oculoglandular form: Patients have painful, red eyes, often with a yellow discharge and crusting. Swollen glands may occur in the jaw, neck or around the ear. [dph.illinois.gov]
Tularemia (Francisella tularensis) Clinical criteria Any person with at least one of the following clinical forms: - Ulceroglandular tularemia - Cutaneous ulcer AND - Regional lymphadenopathy - Glandular tularemia - Enlarged and painful lymph nodes without [hpsc.ie]
Multimedia Current Issue Learning/CME Learning/CME CME Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Case 39-2022: A 31-Year-Old Woman with Postpartum Abdominal Pain [nejm.org]
Respiratory symptoms, chest pain and a cough may also be present. About 35 percent of untreated naturally acquired typhoidal cases die. [luriechildrens.org]
MD, PhD, second year fellow, had a featured case in the New England Journal of Medicine of Glandular Tularemia.A 68-year-old man from Missouri presented to the primary care clinic with a history of 1 week of fever followed by 2 months of progressive, painful [infectiousdiseases.wustl.edu]
- Lymphadenopathy
[…] apparent ulcer - Oculoglandular tularemia - Conjunctivitis AND - Regional lymphadenopathy - Oropharyngeal tularemia - Cervical lymphadenopathy AND at least one of the following three: - Stomatitis - Pharyngitis - Tonsillitis - Intestinal tularemia At [hpsc.ie]
The clinical illness was mild, consisting of fever, headache, and lymphadenopathy. All lymphadenopathy was in the head and neck area. Dermacentor variabilis ticks were identified as the vector. [jamanetwork.com]
Sans traitement, la mortalité varie de 6 % chez les personnes atteintes de tularémie ulcéro-glandulaire jusqu'à 33 % chez les personnes atteintes des formes typhoïde, pulmonaire, ou septicémique. ulceroglandular (cutaneous ulcer with regional lymphadenopathy [context.reverso.net]
Differential included lymphadenitis, reactive lymphadenopathy, a cystic lesion, abscess, atypical mycobacterial infection, and malignancy. [shmabstracts.org]
A delay in diagnosis was associated with persistent lymphadenopathy on follow-up examination (p = 0.05). [link.springer.com]
- Malaise
It is characterized by fever, chills, headache, malaise, an ulcerated skin lesion and painful glands. The skin lesion is usually located on the fingers or hand where contact occurs. [luriechildrens.org]
Respiratoric
- Pharyngitis
Bubo aspirates tested by PCR were positive in 4/4 cases and pharyngeal swabs also tested by PCR were positive in 2/3 cases. Francisella tularensis was isolated from the water samples. [link.springer.com]
[…] tularemia - Enlarged and painful lymph nodes without apparent ulcer - Oculoglandular tularemia - Conjunctivitis AND - Regional lymphadenopathy - Oropharyngeal tularemia - Cervical lymphadenopathy AND at least one of the following three: - Stomatitis - Pharyngitis [hpsc.ie]
Similar articles [Tonsillo-pharyngeal form of tularemia]. Trnjak Z, Nozić D, Marinković V, Bojić I, Lako B, Begović V, Mikić D. Trnjak Z, et al. Vojnosanit Pregl. 1997 May-Jun;54(3):217-21. Vojnosanit Pregl. 1997. PMID: 9304282 Serbian. [pubmed.ncbi.nlm.nih.gov]
- Aspiration
There are no clear recommendations as to whether fine needle aspiration or excision of the mass is superior, as a portion of those FNAs require full excision (4). [shmabstracts.org]
Bubo aspirates tested by PCR were positive in 4/4 cases and pharyngeal swabs also tested by PCR were positive in 2/3 cases. Francisella tularensis was isolated from the water samples. [link.springer.com]
Gastrointestinal
- Abdominal Pain
Pain and Fever Clinical Cases Resource Center Interactive Medical Cases Image Challenge Videos in Clinical Medicine NEJM Resident 360 NEJM Knowledge+ View all learning/CME View all learning/CME Other NEJM Group Learning Hand Hygiene Essential information [nejm.org]
[…] tularemia - Conjunctivitis AND - Regional lymphadenopathy - Oropharyngeal tularemia - Cervical lymphadenopathy AND at least one of the following three: - Stomatitis - Pharyngitis - Tonsillitis - Intestinal tularemia At least one of the following three: - Abdominal [hpsc.ie]
- Vomiting
Conjunctivitis AND - Regional lymphadenopathy - Oropharyngeal tularemia - Cervical lymphadenopathy AND at least one of the following three: - Stomatitis - Pharyngitis - Tonsillitis - Intestinal tularemia At least one of the following three: - Abdominal pain - Vomiting [hpsc.ie]
Oropharyngeal form: From eating undercooked infected meat, this form is associated with a sore throat, stomach pain, nausea, vomiting, diarrhea and occasionally stomach bleeding. [dph.illinois.gov]
- Diarrhea
Oropharyngeal form: From eating undercooked infected meat, this form is associated with a sore throat, stomach pain, nausea, vomiting, diarrhea and occasionally stomach bleeding. [dph.illinois.gov]
- Nausea
Oropharyngeal form: From eating undercooked infected meat, this form is associated with a sore throat, stomach pain, nausea, vomiting, diarrhea and occasionally stomach bleeding. [dph.illinois.gov]
Skin
- Ulcer
There are six main types of tularemia with different effects: Ulceroglandular form: Patients have a skin ulcer(s) and swollen tender glands. Glandular form: Patients have swollen glands without a skin ulcer. [dph.illinois.gov]
Tularemia (Francisella tularensis) Clinical criteria Any person with at least one of the following clinical forms: - Ulceroglandular tularemia - Cutaneous ulcer AND - Regional lymphadenopathy - Glandular tularemia - Enlarged and painful lymph nodes without [hpsc.ie]
[…] survenir après inhalation ou par dissémination hématogène à partir d'un autre type de tularémie; elle se développe dans 10 à 15% des cas de tularémie ulcéroganglionnaire et dans environ 50% des cas de tularémie typhoïdique. ulceroglandular (cutaneous ulcer [context.reverso.net]
Abstract Tularemia is a rare zoonosis occuring in many clinical forms, including ulceral, glandular, oropharyngeal, pneumonic, and septic form. [pubmed.ncbi.nlm.nih.gov]
- Skin Ulcer
There are six main types of tularemia with different effects: Ulceroglandular form: Patients have a skin ulcer(s) and swollen tender glands. Glandular form: Patients have swollen glands without a skin ulcer. [dph.illinois.gov]
It is characterized by fever, chills, headache, malaise, an ulcerated skin lesion and painful glands. The skin lesion is usually located on the fingers or hand where contact occurs. [luriechildrens.org]
Psychiatrical
- Suggestibility
Although the mild clinical illness suggested Francisella tularensis, type B, was the agent, both type A and type B strains of F tularensis were isolated from ticks collected from dogs in the area. [jamanetwork.com]
Repeat tularemia serologies again showed borderline IgM and negative IgG, suggesting the final diagnosis of glandular tularemia. Discussion: Tularemia is an infection caused by the bacteria, Francisella tularensis. [shmabstracts.org]
Workup
Microbiology
- Francisella Tularensis
#NEJM #clinical #photo #lymph #Francisella #tularensis #glandular #tularemia [grepmed.com]
tularensis from a clinical specimen - Detection of Francisella tularensis nucleic acid in a clinical specimen - Francisella tularensis specific antibody response Epidemiological criteria At least one of the following three epidemiological links: - Exposure [hpsc.ie]
Detection of Francisella tularensis in ulcers of patients with tularemia by PCR. J Clin Microbiol 1997; 35: 1045–1048. [link.springer.com]
Infectious agent: : Francisella tularensis Description of illness: Tularemia is caused by Francisella tularensis bacteria; rabbits, hares and rodents are the natural hosts. [tn.gov]
Although the mild clinical illness suggested Francisella tularensis, type B, was the agent, both type A and type B strains of F tularensis were isolated from ticks collected from dogs in the area. [jamanetwork.com]
Treatment
Tularemia serologies returned with “borderline IgM, negative IgG,” prompting treatment with a 10 day course of ciprofloxacin. [shmabstracts.org]
Epidemiology, clinical manifestations, diagnostic procedures and treatment of tularemia, as well as diagnostic pitfalls are briefly discussed. Similar articles [Tonsillo-pharyngeal form of tularemia]. [pubmed.ncbi.nlm.nih.gov]
This type of response can prevent ongoing exposure, as well as provide expeditious treatment to mitigate persistent symptoms. [link.springer.com]
Forme septicémique Without treatment, mortality varies from 6% in people with ulceroglandular tularemia to as high as 33% in people with typhoidal, pneumonic, or septicemic tularemia. [context.reverso.net]
Epidemiology
Probable case Any person meeting the clinical criteria and with an epidemiological link C. Confirmed case Any person meeting the clinical and the laboratory criteria Current as of: 7 March 2019 [hpsc.ie]
Tularemia: current epidemiology and disease management. Infect Dis Clin North Am 2006; 20: 289–311. Article PubMed Google Scholar Eliasson H, Lindbäck J, Nuorti JP, et al. [link.springer.com]
Epidemiology, clinical manifestations, diagnostic procedures and treatment of tularemia, as well as diagnostic pitfalls are briefly discussed. Similar articles [Tonsillo-pharyngeal form of tularemia]. [pubmed.ncbi.nlm.nih.gov]
Prevention
Bedside US provides additional information that can prevent unnecessary procedural attempts at the bedside, and there is increasing evidence that US increases diagnostic accuracy in skin and soft tissue infections and often changes management (2,3). [shmabstracts.org]
Prevention of illness after contact Health care providers can give out antibiotics for up to 14 days. [dph.illinois.gov]
This type of response can prevent ongoing exposure, as well as provide expeditious treatment to mitigate persistent symptoms. [link.springer.com]