TULAREMIA: A CHANGING PRESENTATION IN CHILDREN

Abstract

Tularemia, a febrile zoonosis in children, has a changing clinical presentation. We reviewed 23 cases of tularemia in children at the Arkansas Children's Hospital (ACH, 1975-1983); pediatric cases represented 28/71 tularemia cases in Arkansas in 1983 (39%, 9 at ACH). The demographic data revealed: 1) Age: 0-3 yrs - 5/23, 4-10 yrs - 11/23, and 11-19 yrs - 7/23 (8.2±4.5 yrs); 2) male - 72%; 3) white - 91%; 4) rural - 78%; and 5) season - summer (52%), spring/fall (30%), winter (13%). Transmission by a tick vector (65%), rabbit exposure (9%), other game animals (4%) and multiple exposures (4%). The types of tularemia included: ulceroglandular (35%), glandular (43%), oculoglandular (4%), pneumonic (13%), oropharyngeal (9%). Clinical features included: fever (91%, 103.5°F±1.4°F), lymphadenopathy (91%), pharyngitis (43%) and radiographic evidence of pneumonia (30%, 3/7 due to tularemia). The diagnosis was made by serology (87%), culture (4%) and history/physical (13%). There were no deaths and the most frequent morbidity was late lymph node suppuration (52%). Tularemia in Ark. has increased - 1978 (29), 1979 (42), 1980 (56), 1981 (54), 1982 (69), and 1983 (71). The major changes in tularemia include: 1) an increase in cases in children, 2) an increase in tick exposure over game animal exposure, 3) an absence of typhoidal tularemia, 4) a milder disease with no deaths, and 5) an increase in tularemia pneumonia in children.