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3.
J Radiol Case Rep ; 11(1): 1-6, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28580063

RESUMEN

Francisella tularensis, the causative organism in Tularemia, is a relatively rare disease. There are a few radiological clues to elucidate its presence when suspicion arises. There should be strong consideration for Tularemia in the differential of any patient with its classic symptoms, diffuse cervical lymphadenopathy with evidence of necrosis, and enlarged adenoids. Ultrasound may demonstrate suppurative lymphadenopathy suggestive of infection, as in the case presented. CT often will demonstrate the extent of lymphadenopathy. On chest radiography, tularemia pneumonia is often the presenting finding, which may demonstrate bilateral or lobar infiltrates. Additionally, hilar lymphadenopathy and pleural effusions are often associated findings. Cavitary lesions may be present, which are better delineated on CT scan. We present a case of a 7-year-old male who presented with a painful right-sided palpable neck mass for 9 days, who was diagnosed with Tularemia after numerous admissions.


Asunto(s)
Tomografía Computarizada por Rayos X , Tularemia/diagnóstico por imagen , Antibacterianos/uso terapéutico , Niño , Terapia Combinada , Diagnóstico Diferencial , Gentamicinas/uso terapéutico , Humanos , Masculino , Cuello , Tularemia/terapia , Ultrasonografía
4.
Diagn Interv Radiol ; 22(5): 430-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27498683

RESUMEN

PURPOSE: We aimed to evaluate the ultrasonography (US) and contrast-enhanced computed tomography (CECT) findings of tularemia in the neck. METHODS: US and CECT findings of 58 patients with serologically proven tularemia were retrospectively evaluated. Forty-eight patients underwent US and 42 patients underwent CECT. Lymph node characteristics and parotid preauricular region involvement were analyzed using US and CECT. In addition, involvement of larynx, oropharynx, and retropharynx; presence of periorbital edema; and neck abscess formation were evaluated using CECT. Fine needle aspiration cytology (FNAC) results of enlarged lymph nodes were analyzed in 29 patients. RESULTS: Hypoechoic pattern, round shape, absence of hilum, and cystic necrosis were seen in most of the lymph nodes especially at level 2 and 3 on US and CECT. Matting was more commonly observed than irregular nodal border on US and CECT. Parotid preauricular region involvement was seen in 20.8% of patients on US. Oropharyngeal, retropharyngeal, laryngeal and parotid preauricular region involvement and periorbital edema were seen in 52.4%, 19.1%, 4.8%, 31%, and 9.5% of tularemia patients, respectively. Neck abscess was found in 59.5% of patients on CECT. Suppurative inflammation was the most common finding of FNAC. CONCLUSION: Tularemia should be considered in the presence of level 2 and 3 lymph nodes with cystic necrosis, matting, absence of calcification, oropharyngeal and retropharyngeal region involvement, and neck abscess, particularly in endemic areas.


Asunto(s)
Ganglios Linfáticos/patología , Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Tularemia/diagnóstico por imagen , Adolescente , Adulto , Anciano , Biopsia con Aguja Fina , Niño , Medios de Contraste , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ultrasonografía , Adulto Joven
5.
Vector Borne Zoonotic Dis ; 14(8): 571-5, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25072987

RESUMEN

AIM: The aim of this study was to determine the clinical characteristics and sonographic features of lymphadenopathy (LAP) and to evaluate the treatment modalities and treatment outcomes in children with tularemia. MATERIALS AND METHODS: Demographic characteristics, ultrasonographic and physical examination findings, and treatment outcomes in 55 tularemia patients (24 male and 31 female) with a mean age of 10.8 ± 4.0 years were analyzed retrospectively. Lymph node necrosis was classified in three stages based on ultrasound findings-stage 1, cortical microabscesses; stage 2, cortical and medullar abscesses; stage 3, total necrosis of the lymph node. RESULTS: In total, 50 (90%) of the patients had oropharyngeal, four (8%) had glandular, and one (2%) had oculoglandular tularemia. The most common symptoms were sore throat (67%) and fever (64%). LAP was the most frequently (100%) observed sign. Abscess formation was noted in 36 (65%) patients, of which seven (19%) were sonographically classified as stage 1, 20 (55%) as stage 2, and nine (26%) as stage 3. There was a statistically significant correlation between delayed treatment and stage of abscess formation in lymph nodes (p<0.05). Treatment failure was observed in 24 (44%) patients. There was no significant correlation between treatment regimen and treatment failure (p>0.05). In all, nine (16%) of the patients did not respond to medical treatment, and surgical intervention was required. CONCLUSION: Tularemia should be considered in the differential diagnosis of children presenting with unexplained fever, sore throat, and cervical LAP in endemic areas. Sonographic findings may be useful in the evaluation and staging of this infection.


Asunto(s)
Antibacterianos/uso terapéutico , Ganglios Linfáticos/diagnóstico por imagen , Enfermedades Linfáticas/diagnóstico por imagen , Tularemia/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Francisella tularensis/inmunología , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Enfermedades Linfáticas/patología , Masculino , Estudios Retrospectivos , Insuficiencia del Tratamiento , Tularemia/tratamiento farmacológico , Tularemia/patología , Tularemia/cirugía , Turquía , Ultrasonografía
7.
PLoS One ; 6(9): e24654, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21931798

RESUMEN

BACKGROUND: Pneumonic tularemia is caused by inhalation of the gram negative bacterium, Francisella tularensis. Because of concerns that tularemia could be used as a bioterrorism agent, vaccines and therapeutics are urgently needed. Animal models of pneumonic tularemia with a pathophysiology similar to the human disease are needed to evaluate the efficacy of these potential medical countermeasures. PRINCIPAL FINDINGS: Rabbits exposed to aerosols containing Francisella tularensis strain SCHU S4 developed a rapidly progressive fatal pneumonic disease. Clinical signs became evident on the third day after exposure with development of a fever (>40.5°C) and a sharp decline in both food and water intake. Blood samples collected on day 4 found lymphopenia and a decrease in platelet counts coupled with elevations in erythrocyte sedimentation rate, alanine aminotransferase, cholesterol, granulocytes and monocytes. Radiographs demonstrated the development of pneumonia and abnormalities of intestinal gas consistent with ileus. On average, rabbits were moribund 5.1 days after exposure; no rabbits survived exposure at any dose (190-54,000 cfu). Gross evaluation of tissues taken at necropsy showed evidence of pathology in the lungs, spleen, liver, kidney and intestines. Bacterial counts confirmed bacterial dissemination from the lungs to the liver and spleen. CONCLUSIONS/SIGNIFICANCE: The pathophysiology of pneumonic tularemia in rabbits resembles what has been reported for humans. Rabbits therefore are a relevant model of the human disease caused by type A strains of F. tularensis.


Asunto(s)
Neumonía/diagnóstico por imagen , Neumonía/microbiología , Tularemia/diagnóstico por imagen , Tularemia/microbiología , Animales , Antígenos CD13/sangre , Ingestión de Alimentos , Humanos , Ileus/microbiología , Intestinos/microbiología , Riñón/microbiología , Hígado/microbiología , Pulmón/microbiología , Linfopenia/microbiología , Recuento de Plaquetas , Neumonía/sangre , Conejos , Radiografía , Bazo/microbiología , Tularemia/sangre
8.
Kulak Burun Bogaz Ihtis Derg ; 21(5): 257-60, 2011.
Artículo en Turco | MEDLINE | ID: mdl-21919830

RESUMEN

OBJECTIVES: This study aims emphasize oropharyngeal tularemia in the differential diagnosis of infected lymphadenopathy in the neck region. PATIENTS AND METHODS: Twenty patients (13 males, 7 females; mean age 23 years; range 9 to 43 years) diagnosed with tularemia among those who admitted to our clinic between October 2008 - October 2010 with the complaint of lymphadenopathy in the neck, and underwent treatment were included in this study. The radiological, microbiological, histopathological, and laboratory records of the patients were evaluated. RESULTS: All patients with lymphadenitis in neck who were diagnosed with tularemia came from rural areas. Twelve patients had a history of tonsillopharyngitis that pre-existed before the beginning of lymphadenitis or coexisted with lymphadenitis. All lymphadenopathies of the neck was localized in region II, without side predominance. All patients were diagnosed by serological testing. In 12 of the patients who developed abscesses, repeated puncture of the abscess was performed in addition to the medical treatment. Surgical drainage procedure was not applied any patient. CONCLUSION: The tularemia disease should always be considered in the differential diagnosis of patients with neck lymphadenopathy.


Asunto(s)
Enfermedades Faríngeas/epidemiología , Tularemia/epidemiología , Adolescente , Adulto , Niño , Femenino , Francisella tularensis/aislamiento & purificación , Humanos , Enfermedades Linfáticas/diagnóstico , Enfermedades Linfáticas/diagnóstico por imagen , Enfermedades Linfáticas/epidemiología , Enfermedades Linfáticas/microbiología , Enfermedades Linfáticas/patología , Masculino , Cuello , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/microbiología , Enfermedades Faríngeas/patología , Radiografía , Estudios Retrospectivos , Tularemia/diagnóstico , Tularemia/diagnóstico por imagen , Tularemia/microbiología , Tularemia/patología , Turquía/epidemiología , Resistencia betalactámica
9.
Scand J Infect Dis ; 40(10): 811-4, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18609195

RESUMEN

Cervical contrast-enhanced computed tomography (CECT) was performed in 16 cases (5M, 11F) of oropharyngeal tularaemia, diagnosed at Zonguldak Karaelmas University, Turkey, between January 2004 and March 2006. All patients showed lymphadenopathy with contrast enhancement, 12 of them with peripheral contrast enhancement. Lymph node necrosis was found in 13 of the patients, abscess formation in 9 and cyst formation in 13. This appears to be the largest series of cervical CECT in oropharyngeal tularaemia reported to date. Tularaemia is a differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical lymphadenopathy.


Asunto(s)
Orofaringe/diagnóstico por imagen , Enfermedades Faríngeas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Tularemia/diagnóstico por imagen , Absceso , Adolescente , Adulto , Anciano , Femenino , Humanos , Ganglios Linfáticos/patología , Enfermedades Linfáticas/patología , Linfocele , Masculino , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Necrosis , Orofaringe/patología , Enfermedades Faríngeas/patología , Estudios Retrospectivos , Tularemia/patología , Turquía
11.
Bone Marrow Transplant ; 24(2): 197-9, 1999 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10455349

RESUMEN

We report a case of tularemia presenting as a solitary pulmonary nodule following syngeneic PBSC transplant. Seven months after undergoing a syngeneic PBSC transplant for AML, our patient presented with fever without localizing signs. Chest X-ray revealed a solitary pulmonary nodule. Culture of a CT guided needle aspiration revealed Francisella tularensis. The patient was successfully treated with ciprofloxacin. His fever resolved and clearance of the nodule was documented on a CT scan 2 months after diagnosis and initiation of treatment. To our knowledge, this is the only reported case of tularemia occurring in the post-transplant setting. The possible relationship between transplant-induced immune dysfunction and the occurrence of this rare infection is discussed.


Asunto(s)
Francisella tularensis/aislamiento & purificación , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Leucemia Mieloide Aguda/terapia , Tularemia/etiología , Antiinfecciosos/uso terapéutico , Ciprofloxacina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Trasplante Homólogo , Tularemia/diagnóstico por imagen , Tularemia/tratamiento farmacológico
12.
Pediatr Radiol ; 20(6): 483-4, 1990.
Artículo en Inglés | MEDLINE | ID: mdl-2392370

RESUMEN

The CT appearance of oropharyngeal tularemia in a 3 1/2 year-old boy is described. Tularemia should be considered in the differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical adenopathy.


Asunto(s)
Enfermedades Linfáticas/diagnóstico por imagen , Orofaringe/diagnóstico por imagen , Tularemia/diagnóstico por imagen , Preescolar , Diagnóstico Diferencial , Francisella tularensis , Humanos , Masculino , Cuello , Necrosis , Orofaringe/patología , Tomografía Computarizada por Rayos X , Tularemia/patología , Tularemia/transmisión
13.
Scand J Infect Dis ; 17(4): 371-5, 1985.
Artículo en Inglés | MEDLINE | ID: mdl-4089543

RESUMEN

In a tularemia epidemic during 1982 in northern Finland, 53 patients showed no peripheral portal of entry for infection or associated lymphadenopathy. Respiratory symptoms were observed in 72% of the patients. 26/38 cases had abnormal chest films. Hilar adenopathy was the most common finding (36%). Four patients did not receive antibiotics; 43 received tetracyclines, 5 streptomycin and 1 cefuroxime and amoxycillin. All patients recovered. 50 patients acquired the infection during common farming activities, such as making fresh hay with a hay-cutter, handling dry hay, threshing, etc. Thus, airborne transmission may be an important source of infection in normal farming activities in endemic areas of tularemia.


Asunto(s)
Agricultura , Microbiología del Aire , Tularemia/transmisión , Finlandia , Francisella tularensis , Humanos , Radiografía , Tularemia/diagnóstico por imagen , Tularemia/patología
15.
AJR Am J Roentgenol ; 131(2): 277-81, 1978 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-98007

RESUMEN

Pleuropulmonary disease was seen in 50 of 62 patients (81%) with proven tularemia. Radiographic findings included patchy subsegmental air space opacities (74%), hilar lymphadenopathy (32%), and pleural effusion (30%). Less common manifestations were air space opacification of an entire lobe or segment, cavitation, oval opacities, pericardial effusion, linear opacities and septal lines, apical and miliary disease resembling tuberculosis, a mediastinal mass, empyema with bronchopleural fistula, and residual cystic changes, calcification, and fibrosis. Pleuropulmonary tularemia may be easily misdiagnosed as other infectious diseases, neoplastic diseases, and occasionally cardiac or other pericardial disease. It should be considered whenever patients from endemic areas present a perplexing radiographic and clinical picture. Such patients should have the benefit of a serologic examination for tularemia, since this disease may be effectively controlled with appropriate antibiotics.


Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Tularemia/diagnóstico por imagen , Adolescente , Adulto , Anciano , Arkansas , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía
17.
Infect Immun ; 5(5): 734-44, 1972 May.
Artículo en Inglés | MEDLINE | ID: mdl-4629251

RESUMEN

The pathogenesis of tularemia was studied in groups of rhesus monkeys (Macaca mulatta) that inhaled graded 10-fold doses ranging from 10 through 10(6) organisms of Francisella tularensis 425, a strain highly virulent for the white mouse but of reduced virulence for the domestic rabbit. Mean incubation periods ranged from 3 to 6 days followed by acute illness lasting 5 to 11 days with subsequent recovery of most animals. The higher inhaled doses resulted in shorter incubation periods, longer and more severe acute illnesses, and 18% mortality at the highest dose. Strain 425 multiplied in the lungs, disseminated to the regional lymph nodes, and became systemic. Maximal bacterial populations in tissues were reached by the 7th day after exposure of the animals regardless of the number of organisms inhaled. F. tularensis was no longer recoverable from any of six tissues examined 2 months after exposure. The most significant tissue changes occurred in the lungs; these consisted of foci of liquefaction necrosis, lobular consolidation, and pleural effusion and adhesions. The data indicate that the inhaled dose of strain 425 determined the maximal growth of the organism in the lungs which in turn influenced the severity of the usually self-limiting pneumonia and systemic infection. Although the monkey is less resistant to tularemia than is man, this laboratory animal when infected with F. tularensis 425 provides a useful model for the self-limiting type of human pulmonary tularemia usually observed in Europe and Asia but to a lesser extent in North America.


Asunto(s)
Francisella tularensis/patogenicidad , Tularemia/microbiología , Aerosoles , Animales , Temperatura Corporal , Peso Corporal , Fémur/microbiología , Fémur/patología , Fermentación , Francisella tularensis/metabolismo , Glicerol/metabolismo , Haplorrinos , Pruebas de Hemaglutinación , Hígado/microbiología , Hígado/patología , Pulmón/microbiología , Pulmón/patología , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Macaca , Radiografía , Bazo/microbiología , Bazo/patología , Factores de Tiempo , Tularemia/sangre , Tularemia/diagnóstico por imagen , Tularemia/patología
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