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Tularemia in children
Last reviewed: 06.07.2025
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Tularemia is a natural focal acute infectious disease with fever, specific lymphadenitis and damage to various organs.
ICD-10 code
- A21.0 Ulceroglandular tularemia.
- A21.1 Oculoglandular tularemia.
- A21.2 Pulmonary tularemia.
- A21.3 Gastrointestinal tularemia.
- A21.7 Generalized tularemia.
- A21.8 Other forms of tularemia.
- A21.9 Tularemia, unspecified.
Causes of tularemia
The causative agent Francisella tularensis is a small (0.2-0.5 µm) non-motile gram-negative rod that grows well under aerobic conditions on nutrient media with the addition of cysteine, glucose and blood products.
Pathogenesis of tularemia
The pathogen enters the body through the skin or mucous membranes of the eyes, respiratory tract, gastrointestinal tract. At the site of pathogen introduction, a primary affect often occurs in the form of an ulcerative-necrotic defect and regional lymphadenitis. When the lymphatic barrier is broken, the pathogen and its toxins enter the blood, which marks the occurrence of bacteremia and generalization of the process, as a result of which metastasis of the infection is possible with the formation of secondary tularemia buboes and damage to internal organs.
Epidemiology
Tularemia is a typical natural focal zoonotic infection. In natural foci, the main source of infection is rodents: water rats and mice. Infection of many domestic animals, as well as various parasitic ticks and insects, has been established. A sick person does not play a role as a source of infection in tularemia.
Causes and pathogenesis of tularemia
Classification
Depending on the route of infection and the primary localization of the infection, there are bubonic, ulcerative-bubonic, oculobubonic, anginal-bubonic, abdominal, pulmonary and generalized forms of tularemia.
Symptoms of tularemia
The bubonic form occurs when the pathogen penetrates through the skin. It is characterized by swelling of the lymph nodes near the gate of infection. Most often, one, less often several lymph nodes are enlarged. Buboes are moderately painful, with clear contours, the size of a chicken egg. Subsequently, buboes can slowly resolve, but often in the 3rd-4th week from the moment of appearance they soften, fester, the skin above them becomes edematous and hyperemic. The bubo opens with the release of creamy pus. A fistula is formed with subsequent scarring and sclerosis.
Diagnosis of tularemia
Tularemia is diagnosed based on a combination of clinical, epidemiological and laboratory data. Of the epidemiological data, contact with animals in the natural focus of infection is of the greatest importance.
Treatment of tularemia
Levomycetin, gentamicin, erythromycin, third-generation cephalosporins and other antibiotics are used in normal doses for 7-10 days.
Skin ulcers are treated with ointment dressings, and buboes with local compresses. In case of suppuration, buboes are opened with a wide incision with the evacuation of pus and necrotic masses.
Prevention of tularemia
Vaccination against tularemia is used. Of great importance is the extermination of rodents by using pesticides, as well as the fight against ticks by special treatment of domestic animals and the territory affected by ticks. Measures to protect water sources, stores, warehouses and especially homes from penetration are of great importance.
What tests are needed?
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