Rare clinical cases of tularemia

Abstract

The most common clinical form of tularemia in Europe is ulcerative bubonic , which has a summer-autumn seasonality . When infected with water and food , the development of oropharyngeal and abdominal forms is possible . The rarity of registration of such forms is associated not only with the low frequency of such cases of infection , but also with the complexity of diagnosing diseases with an atypical clinic . Important for the correct diagnosis are the results of specific laboratory diagnostics and a qualitatively collected epidemiological history . The results of zooparasitological monitoring allow assessing the risk of infection in certain territories . The article provides descriptions of two cases of severe abdominal tularemia , registered in autumn 2021 – winter 2022 in the Republic of Karelia , which has been one of the most disadvantaged regions of Russia in recent years . In the first case , in a 15-year-old boy , the disease began acutely , the main symptoms were high fever , abdominal pain , vomiting , loose stools , foci of skin hyperemia with clear uneven edges without infiltration in the left knee joint and right inguinal region , hepatomegaly , mesoadenitis . In indirect gemagglutination reaction with tularemia diagnosticum on the third day from the onset of the disease antibodies in titer 1:640. Infection probably occurred when eating food during a trip to the forest zone of the city , where infected rodents were previously detected . In the second case , a 17-year-old girl living in a village was diagnosed with a peritonsillar abscess 3 weeks before a sharp rise in temperature , abdominal pain , vomiting and loose stools . Later he developed renal and hepatic insufficiency , polyserositis . The antibodies titer was 1:320 after 3 weeks and 1:2650 after 5 weeks . Infection probably occurred through consumption of rodent-contaminated v egetables .