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Tularemia in children
Last reviewed: 20.11.2021
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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
Pathogen Francisella tularensis - small (0.2-0.5 microns) immobile gram-negative rod, grows well under aerobic conditions on nutrient media with the addition of cysteine, glucose and blood products.
Pathogenesis of tularemia
The causative agent enters the body through the skin or mucous membranes of the eyes, respiratory tract, GIT. At the site of the pathogen introduction, a primary affect often occurs in the form of ulcerative necrotic defect and regional lymphadenitis. With the breakthrough of the lymphatic barrier, the pathogen and its toxins enter the bloodstream, which signifies the emergence of bacteremia and generalization of the process, as a result of which metastasis of the infection with the formation of secondary tularemia buboes and damage to internal organs is possible.
Epidemiology
Tularemia is a typical natural focal zoonotic infection. In natural foci the main source of infection is rodents: water rats and mice. The infection of many domestic animals, as well as various parasitic ticks and insects has been established. A sick person as a source of infection with tularemia does not play a role.
Causes and pathogenesis of tularemia
Classification
Depending on the path of infection and the primary localization of infection, bubonic, ulcerative-bubonic, glazobubonic, anginal-bubonic, abdominal, pulmonary and generalized forms of tularemia are distinguished.
Symptoms of tularemia
Bubonic form occurs when penetrating the pathogen through the skin. It is characterized by swelling of lymph nodes near the gate of infection. More often one grows, less often a few lymph nodes. Bubbons moderately painful, with clear contours, the size of a chicken egg. Subsequently, buboes can slowly dissolve, but often on the 3-4th week from the moment they appear they soften, get nagged, the skin over them becomes edematous and hyperemic. Bubon is opened with the release of creamy pus. A fistula is formed, followed by scarring and sclerosing.
Diagnosis of tularemia
Tularemia is diagnosed on the basis of a combination of clinical, epidemiological and laboratory data. From epidemiological data, contact with animals in the natural focus of infection is most important.
Treatment of tularemia
Apply levomitsetin, gentamicin. Erythromycin, third generation cephalosporins and other antibiotics in usual doses for 7-10 days.
Skin ulcers are treated with ointment dressings, and buboes - with local compresses. In case of pyesis, buboes are opened with a wide incision with the evacuation of pus and necrotic masses.
Prevention of tularemia
Used vaccine against tularemia. Of great importance is the extermination of rodents by the use of pesticides, as well as the fight against mites by special treatment of domestic animals and the territory affected by mites. Measures to protect water supply sources, stores, warehouses and especially dwellings from penetration are of great importance.