Ulceroglandular Tularemia


Ulceroglandular Tularemia

April 8, 2021
N Engl J Med 2021; 384:1349
DOI: 10.1056/NEJMicm2031676

List of authors.

  • Michael Buettcher, M.D.,
  • and Chiara Imbimbo, B.M.

A 5-year-old girl presented to the pediatric emergency department with a 4-week history of painful swelling on both sides of her lower abdomen. Pets that she had regular contact with included a cat and a dog. Six weeks before presentation, her parents had noticed a tick buried in her umbilicus and had removed it with tweezers. Five days later, the patient had fever, loss of appetite, fatigue, and redness around the umbilicus (Panel A). These symptoms abated after 4 days. At the time of this presentation, examination showed marked inguinal lymphadenopathy on both sides (Panel B). Treatment with oral ciprofloxacin was initiated for suspected ulceroglandular tularemia. Serologic testing supported the diagnosis; the Francisella tularensis antibody titer was 1:1280. Two weeks after the completion of treatment, there was a reduction in the lymphadenopathy. After an additional 2 weeks, the swelling had completely resolved.

For more:

According to DHS, tularemia in Wisconsin is rare, with less than one case per year since 1980.  In 2016, a tularemia alert was given for La Crosse due to the death of three infected cats.  And according to this report, while rabbits are the main source of transmission in Wisconsin, aquatic mammals (muskrat, beaver), woodticks, upland game birds: (partridge, pheasant, prairie chicken), cats, squirrels, deer-fly bites, skunks horses, sick dogs which killed rabbits, foxes, possible skunk, mink, muskrat or raccoon are also responsible.  One case was recorded from exposure to a contaminated stream.  It’s been called “Deer-fly Fever.”

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