Delayed Diagnosis of Tularemia in a Nonendemic Area: A Report of Three Cases/Endemik Olmayan Bir Bolgede Tanisi Gecikmis Tularemi: Uc Olgu Bildirisi

Tularemia is a zoonotic disease which emerges as epidemics or sporadic cases and maintains its importance for public health. It can be confused with infectious and non-infectious diseases because of its clinical diversity, and invasive tests and unnecessary treatments can be applied to patients, especially in nonendemic areas, if it was not considered in differential diagnosis. The first case was referred to the outpatient clinic of infectious diseases and clinical microbiology to investigate the etiology of cervical lymphadenopathy; tularemia was considered based on the negative results of other tests, development of erythema nodosum lesions on follow-up and epidemiological history, and her diagnosis was confirmed serologically by microagglutination test. Serum samples of the second and third cases were sent for tularemia testing on their first admissions based on their epidemiological history. It is remarkable that tularemia was diagnosed about three months after the onset of the symptoms. Klimik Dergisi 2019; 32(2): 206-9. Key Words: Lymphadenopathy, tularemia, Francisella tularensis. Tularemi salginlar ya da sporadik olgular seklinde ortaya cikan ve halk sagligi icin onemini yitirmeyen zoonotik hastaliklardan biridir. Klinik cesitlilik gostermesi nedeniyle infeksiyoz ve infeksiyon disi bircok hastalikla karisabilmektedir. Ozellikle endemik olmayan bolgelerde, ayirici tanida akla gelmezse, invazif tetkikler ve gereksiz tedaviler uygulanabilmektedir. Servikal lenfadenopati etyolojisi arastirilmak uzere infeksiyon hastaliklari ve klinik mikrobiyoloji poliklinigine sevk edilen ilk olguda, diger testlerin negatif olmasina, izlemde gelisen erythema nodosum lezyonlarina ve epidemiyolojik oykuye dayanilarak tularemi dusunulmus; tani, serolojik olarak mikroaglutinasyon testiyle dogrulanmistir. Ikinci ve ucuncu olgularda ise serum ornegi, tularemiyi dusunduren epidemiyolojik oykulerine dayanilarak, hastalarin ilk basvurularinda gonderilmistir. Yine de hastalarin yakinmalarinin baslangiciyla tularemi tanisi konmasi arasinda yaklasik uc ay gecmesi dikkat cekici bulunmustur. Klimik Dergisi 2019; 32(2): 206-9. Anahtar Sozcukler: Lenfadenopati, tularemi, Francisella tularensis.