Hostname: page-component-5db58dd55d-ggg9q Total loading time: 0 Render date: 2026-05-30T19:17:33.075Z Has data issue: false hasContentIssue false
  • English
  • Français

Tularaemia presenting as parapharyngeal abscess: case presentation

Published online by Cambridge University Press:  09 March 2012

S Koc ,
L Gürbüzler ,
H Yaman ,
A Eyibilen ,
N Salman  and
A Ekici
S Koc*
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
L Gürbüzler
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
H Yaman
Affiliation:
Department of Otorhinolaryngology, Düzce University School of Medicine, Turkey
A Eyibilen
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
N Salman
Affiliation:
Department of Otorhinolaryngology, Ankara Children's Hematology and Oncology Hospital, Turkey
A Ekici
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
*
Address for correspondence: Dr Sema Koc, Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey Fax: +90 3562133179 E-mail: drsemakoc@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

We report an extremely rare case of the oropharyngeal form of tularaemia, causing a parapharyngeal abscess.

Case report:

A 48-year-old woman presented with fever, sore throat, breathing difficulty and a right-sided neck swelling. This mass had previously been treated with penicillin without response, and had already been surgically drained once in another hospital. On physical examination, the tonsils were exudative and hypertrophic and the pharynx was hyperaemic. A fluctuant, 4 × 4 cm mass was seen on endoscopic examination, originating from the left parapharyngeal area and protruding towards the pyriform sinus, and partly obstructing the airway. Microagglutination test antibody titres for Francisella tularensis were positive (1/1280). The patient healed completely after definitive drainage of the abscess and antimicrobial therapy for 14 days (streptomycin, 2 × 1 g intramuscularly).

Conclusion:

Tularaemia should be considered in the differential diagnosis of patients presenting with tonsillopharyngitis, cervical lymphadenitis and parapharyngeal abscess who do not respond to treatment with penicillin, even if they do not live in an endemic region.

Keywords

TularemiaPharyngeal DiseaseAbscessDiagnosisOropharynxFrancisella Tularensis

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 535 - 537
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Ellis, J, Oyston, PC, Gren, M, Titball, RW. Tularemia. Clin Microbiol Rev 2002;15:631– 46CrossRefGoogle ScholarPubMed
2Gallego, L, Junquera, L, Palacios, JJ, de Vicente, JC. Cervical tularaemia in a non-endemic area. Med Oral Patol Oral Cir Bucal 2009;14:180–2Google Scholar
3Eliasson, H, Lindbäck, J, Nuorti, JP, Arneborn, M, Giesecke, J, Tegnell, A. The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden. Emerg Infect Dis 2002;8:956–60CrossRefGoogle ScholarPubMed
4Helvaci, S, Gedikoğlu, S, Akalin, H, Oral, HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol 2000;16:271–6CrossRefGoogle ScholarPubMed
5Kantardjiev, T, Ivanov, I, Velinov, T, Padeshki, P, Popov, B, Nenova, R et al. Tularemia outbreak, Bulgaria, 1997–2005. Emerg Infect Dis 2006;12:678–80CrossRefGoogle ScholarPubMed
6Chitadze, N, Kuchuloria, T, Clark, DV, Tsertsvadze, E, Chokheli, M, Tsertsvadze, N et al. Water-borne outbreak of oropharyngeal and glandular tularemia in Georgia: investigation and follow-up. Infection 2009;37:514–21CrossRefGoogle ScholarPubMed
7Foley, JE, Nieto, NC. Tularemia. Vet Microbiol 2010;140:332–8CrossRefGoogle ScholarPubMed
8Eiros Bouza, JM, Rodriguez-Torres, A. Tularemia [in Spanish]. Rev Clin Esp 1998;198:785–8Google ScholarPubMed
9Sjörstedt, A. Tularemia: history, epidemiology, pathogen physiology and clinical manifestations. Ann N Y Acad Sci 2007;1105:1–29CrossRefGoogle Scholar
10Nigrovic, LE, Wingerter, SL. Tularemia. Infect Dis Clin N Am 2008;22:489–504CrossRefGoogle ScholarPubMed
11Eliasson, H, Broman, T, Forsman, M, Bäck, E. Tularemia: current epidemiology and disease management. Infect Dis Clin N Am 2006;20:289–311CrossRefGoogle ScholarPubMed
12Capellan, J, Fong, IW. Tularemia from a cat bite: case report and review of feline-associated tularaemia. Clin Infect Dis 1993;16:472–4CrossRefGoogle Scholar
13Peter, R, Banyai, T. Erythema nodosum revealing oculoglandular tularemia. Dermatology 2001;202:79–80CrossRefGoogle ScholarPubMed
14Gill, V, Cunha, BA. Tularemia pneumonia. Semin Respir Infect 1997;12:61–7Google ScholarPubMed
15Gürkov, R, Kisser, U, Splettstösser, W, Hogardt, M, Krause, E. Tularaemia of middle ear with suppurative lymphadenopathy and retropharyngeal abscess. J Laryngol Otol 2009;123:1252–7CrossRefGoogle ScholarPubMed
16Kroca, M, Tärnvik, A, Sjörstedt, A. The proportion of circulating γδ T cells increases after the first week of onset of tularaemia and remains elevated for more than a year. Clin Exp Immunol 2000;120:280–4CrossRefGoogle ScholarPubMed
17Dlugaiczyk, J, Harrer, T, Zwerina, J, Traxdorf, M, Schwarz, S, Splettstoesser, W et al. Oropharyngeal tularemia – a differential diagnosis of tonsillopharyngitis and cervical lymphadenitis. Wien Klin Wochenschr 2010;122:110–14CrossRefGoogle ScholarPubMed
18Arikan, OK, Koç, C, Bozdoğan, O. Tularemia presenting as tonsillopharyngitis and cervical lymphadenitis: a case report and review of the literature. Eur Arch Otorhinolaryngol 2003;260:298–300CrossRefGoogle ScholarPubMed
19Reintjes, R, Dedushaj, I, Gjini, A, Jorgensen, TR, Cotter, B, Lieftucht, A et al. Tularaemia outbreak investigation in Kosovo: case control and environmental studies. Emerg Infect Dis 2002;8:69–73CrossRefGoogle ScholarPubMed
20Robson, CD. Imaging of granulomatous lesions of the neck in children. Radiol Clin North Am 2000;38:969–77CrossRefGoogle ScholarPubMed
21Lennert, K. Classification and morpohology of non-Hodgkin's lymphomas [in German]. Hamatol Bluttransfus 1976;18:145–50Google Scholar
22Grunow, R, Splettstösser, W, Hirsch, FW, Kleemann, D, Finke, EJ. Differential diagnosis of tularemia [in German]. Dtsch Med Wochenschr 2001;126:408–13CrossRefGoogle ScholarPubMed
23Perez-Castrillon, JL, Bachiller-Luque, P, Martin-Luquero, M, Mena-Martin, FJ, Herreros, V. Tularemia epidemic in northwestern Spain: clinical description and therapeutic responses. Clin Infect Dis 2001;33:573–6CrossRefGoogle Scholar
24Kandemir, B, Erayman, I, Bitirgen, M, Aribas, ET, Guler, S. Tularemia presenting with tonsillopharyngitis and cervical lymphadenitis: report of two cases. Scand J Infect Dis 2007;39:620–2CrossRefGoogle ScholarPubMed