A 31-year-old man presented with fever, right cervical lymph node swelling, and odynophagia.
Right peritonsillar abscess was followed by tonsillectomy á chaud. Under i.v. antibiotic
therapy, the right lymph node swelling did not regress. A melted lymph node was identified
in the neck by CT, which was surgically removed. Francisella tularensis was detected
in this case.
In another case, a 31-year-old woman presented with painful lymph node swelling and
melted lymph node conglomerates cervical bilaterally, depicted by CT. Diagnostic lymph
node extirpation failed to detect the causative agent. Serological testing for rare
pathogens performed in the presence of persistent symptoms finally revealed the presence
of antibodies against Francisella tularensis.
Francisella tularensis is a gram-negative bacterium whose reservoir is wild animals,
especially hares. The incidence is 0.01/100,000 and transmission occurs by direct
contact with infected animals, contaminated water or dust, and consumption of meat
containing the pathogen. Clinical manifestations include ulcers of the skin and swelling
of the lymph nodes, as well as manifestations in the pharynx or eyes. The invasive
form with involvement of internal organs is often lethal. The diagnosis is confirmed
by pathogen cultivation or serological antibody detection. Treatment is performed
using tetracyclines or macrolides.
Tularaemia is a rare but dangerous disease. The nonspecific clinical appearance, the
rarity and the difficult pathogen detection are a challenge for diagnosis and therapy.
The history of exposure to wild animals can be a decisive factor in establishing the
diagnosis.
