Tularemia in Children.

Abstract

To the Editors: We read the article by Imbimbo et al1 regarding tularemia in children and adolescents. In their article, the authors provided a summary of the current knowledge on tularemia epidemiology, clinical presentation, diagnostics, therapy, treatment and prophylaxis in children and adolescents. This study is very important to highlight the differential diagnosis of tularemia that it is broad and varies among the different clinical syndromes. Thus, patients often initially receive an inadequate therapy (mostly β-lactams) before the correct diagnosis being made. Although need of surgical intervention was described as a complication in the article, it can be performed to hasten the healing process.2 In our study of 100 children with tularemia, 74 patients neither required retreatment nor experienced relapses. A surgical procedure was performed for 43 (58.1%) of these 74 patients. The remaining 26 patients experienced relapses that required a second course of therapy (Table 21). All 26 patients received antimicrobial drugs, and 17 underwent surgical procedures. Among these 17 patients, 10 underwent a second surgical procedure.2 In a previous study from Turkey in which a total of 68 patients with oropharyngeal tularemia, including 26 children and 42 adults, were evaluated, a similar proportion of patients in both the pediatric (30.8%) and adult (35.7%) groups required surgical drainage of lymph nodes. There were no statistical differences between the groups in antibiotic usage or in the timing of surgical drainage. It was concluded that a combination of surgical drainage and antibiotic therapy increases treatment success for patients diagnosed with oropharyngeal tularemia.3 Imbimbo et al1 also discussed that to avoid prolonged progression of the disease, treatment failure, early diagnosis and a prompt initiation of adequate antimicrobial therapy are pivotal. It was declared that further research should focus on tools and processes to avoid delayed diagnosis, further evaluation of treatment regimens was needed in children and development of an effective vaccine especially against the more virulent subspecies tularensis is necessary. These studies highlighting the importance of early differential diagnosis of tularemia are very helpful to guide clinicians all over the world, especially in regions where the disease is endemic.