Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia

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Meric M, Willke A, Finke EJ, Grunow R, Sayan M, Erdogan S, Gedikoglu S. Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia. APMIS 2008;116:66–73.

Tularemia outbreaks have occurred in various regions of Turkey in recent years. In this study, clinical (145 patients) and laboratory (97 patients) features of patients with oropharyngeal tularemia were evaluated during the tularemia outbreak in the district of Gölcük in Kocaeli, Turkey. We analyzed the risk factors for therapeutic failure and prolonged recovery time, and compared the efficacy of three antibiotic groups, namely aminoglycoside, tetracycline and quinolone. The most common physical sign and laboratory findings in patients were lymphadenopathy (LAP) and increased erythrocyte sedimentation rate, respectively. Treatment failure was observed in 55 of the 145 (38%) patients during one-year follow-up and the most successful results were obtained in the quinolone group. It was determined that antimicrobial therapy initiated 14 days after onset of symptoms was a statistically significiant risk factor, reducing the success rate (p=0.0001, OR=13.10, 95% CI=5.69–30.15) and prolonging the recovery period (p=0.001, OR=3.23, 95% CI=1.63–6.40) in oropharyngeal tularemia cases. These results suggest that antimicrobial treatment should be started early, and quinolones such as moxifloxacin and ciprofloxacin seem to be new alternatives in the treatment of oropharyngeal tularemia.

Keywords: Oropharyngeal tularemia; quinolones; risk factors; therapeutic failure

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1600-0463.2008.00901.x

Affiliations: 1: Department of Clinical Bacteriology and Infectious Diseases, Medical Faculty, Kocaeli University, Kocaeli, Turkey 2: Bundeswehr Institute of Microbiology, Munich, Germany 3: Kocaeli University, Medical Faculty, Clinical Laboratory, PCR Unit, Kocaeli 4: Istanbul University, Cerrahpasa Medical Faculty, Department of Public Health, İstanbul 5: Department of Microbiology, Medical Faculty Uludagˇ University, Bursa, Turkey

Publication date: January 1, 2008

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