Abstract
Tularemi endemik bölgelerde farklı klinik tabloda görülebilir. İki ay önce boğaz ağrısı, ateş ve sonradan kilo kaybı, kesilmeyen öksürük, şikâyeti ile gelen bir bayan hasta. Yapılan kan biyokimyasında lökositoz (12.500/mm3), hemoglobin 9.9 gr/dl, sedimantasyon (103 mm/saatte), CRP (109 mg/l), ALT(61 I.U) ve AST (54 I.U) yüksekliği saptanmış. Hasta ampisillin tedavisine rağmen düzelme göstermemiş. Çekilen akciğer grafisinde hiler lenfadenomegali, lobular ve nodüler tutulum görülmüş ve bronkoskobide kitle saptanmıştır. Hastada, radyolojik olarak akciğer kanseri düşünülürken, şikâyetlerinin patates tarlasında çalıştıktan sonra geliştiği fark edilmiştir. Yapılan serolojide tularemi antikor testinin 1/1280 de pozitif gelmesi ile olgu sekonder pulmoner pnomoni olacağı düşünülmüştür. Hasta verilen üçlü antibiyotik tedavisi (streptomisin+doksisiklin+ciprofloksasin) ile tamamen düzelmiştir. Tulareminin nadir bir şekli olan pulmoner tutulum endemik bölgelerde akciğer kanseri ile karıştırılabilir. Olgu sunularak pnömonik tularemi literatürler eşliğinde gözden geçirildi.
References
- Sahin M, Atabay HI, Bicakci Z, Unver A, Otlu S. Outbreaks of Tularemia in Turkey. Kobe J. Med. Sci 2007; 53(1): 37-42.
- Korkmaz T, Bicer YÖ, Sirmatel Ö, Sirmatel F. A retrospective analysis of tularemia cases admitted to a tertiary care hospital. Kulak Burun Boğaz Uygulamaları 2013;1(1):11-16
- Bayındır T, Can Ş, Bayındır Y, Kızılay A. Bozok Tıp Derg 2014: 1(1); 54-9,
- Arslanyılmaz M, Aslan D, Akın L, Aktaş D. Türk Hijyen ve Deneysel Biyoloji Dergisi. 2014;71(2):99-106
- Polat M, Parlak AH, Ors I, Sirmatel F. Erythema nodosum and Sweet’s sybdrome in patients with glandular tularemia. International Journal of Dermatology 2011; 50:866-69
- Gürbüz Y, Gülmez ZD, Tütüncü EE, Şencan İ: Bir Tularemil Pnömoni Olgusu. Klimik Dergisi 2019; 32:2010-12
- Matyas BT, Nieder HS, Telford SR. Pneumonic tularemia on Martha’s Vineyard: Clinical epidemiologic and ecological characteristic. Ann NY Acad Sci 2007; 1105:351-77
- Rimawi RH, Shah KB, Chowdhary RA, and Cook PP. Hunting for tularemia-A review of cases in North Carolina. Zoonoses Public Health 2015; 62:159-64
- Fachinger P, Tini GM, Grobholz R, Gambazzi F, Fankhauser H and Irani S. Pulmonary tularemia: All that looks like cancer is not necessarily cancer. Case report of four consecutive cases. BMC Pulm Med 2015; 15:1-6
- Gürcan Ş. Epidemiology of tularemia. Balkan Med J 2014; 31:3-10
- Sharma J, Mares CA, Li Q, Morris EG, Teale JM. Features of sepsis caused by pulmonary infection with Francisella tularensis Type A strain. Microb Pathog 2011; 51:39-47
- Ranjbar R, Behzadi P, Mammina C. Respiratory Tularemia; Francisella Tularensis and Microarray Probe Designing. Open Microbiol Journal 2016; 10:176-82
- Alias T, Fallahzadeh MK, Berhe M. Tularemia presenting as pulmonary nodules in an immuncompromised patient. Baylor Univ Med Cent Proc 2017; 30:175-76
- Naughton M, Brown R, Adkins D, Dipersio J. Tularemia. An unusual cause of a solitary pulmonary nodüle in the post-transplant setting. Bone Marrow Transplant 1999; 24:197-99
- Aktepe E, Sönmezer MC, Yarımoğlu S, Erdiç FS, Ertem G, Tülek N. Geç tanı konulan ülseroglandüler tularemi: Bir olgu sunumu. Klimik Der 2017; 30(2):83-6.
- Erzurumluoğlu N, Sargan A, Yildiz FR, Ozekinci S, Mersinlioglu G. A suppurative granulomatous lymphadenitis agent. Tularemia case report. Med J Okmeydanı Train Res Hosp 2018; 34:41-5
- Erdem H, Ozturk DE, Yesilyurt M. Et all. Evaluation of tularemia courses: A retrospective study from Turkey. Clin Microbiol Infect 2014; 20: 1042-51.
- Çelebi G. Klimik sayfası- https://www.klimik.org.tr/bilgi-merkezi/tularemi/tularemi-yrd-doc-dr-guven-celebi-zonguldak-karaelmas-universitesi-tip-fakultesi
Abstract
Tularemia can be seen in different clinical pictures in endemic regions. A women who came with a complaint of sore throat, fever (380 C) and subsequent weight loss, unceasing cough, and complaints continuing for 2 months. In the blood samples, leukocytosis 12.500/mm3 hemoglobin 9.9 g/dl, sedimentation rate 103 mm/hour, level of C-reactive protein 109 mg/l, alanine aminotransferase 61 i.u and aspartate aminotransferase 54 i.u were determined. The patient did not improve despite the ampicillin treatment. Hilar lymphadenomegaly, lobular and nodular involvement were seen on the X-ray chest and a mass was confirmed by bronchoscopy. It was noticed that the patient developed his complaints after working in the potato field while considering lung cancer radiologically. In the serology when the tularemia antibody test was positive at 1/1280, it was thought that the case would be secondary pulmonary pneumonia. The patient recovered completely with the triple antibiotic treatment (streptomycin, doxycycline and ciprofloxacin) given. Pulmonary involvement, a rare form of tularemia, can be confused with lung cancer in endemic areas. The case was presented and pneumonic tularemia was reviewed with the literature.
Keywords
References
- Sahin M, Atabay HI, Bicakci Z, Unver A, Otlu S. Outbreaks of Tularemia in Turkey. Kobe J. Med. Sci 2007; 53(1): 37-42.
- Korkmaz T, Bicer YÖ, Sirmatel Ö, Sirmatel F. A retrospective analysis of tularemia cases admitted to a tertiary care hospital. Kulak Burun Boğaz Uygulamaları 2013;1(1):11-16
- Bayındır T, Can Ş, Bayındır Y, Kızılay A. Bozok Tıp Derg 2014: 1(1); 54-9,
- Arslanyılmaz M, Aslan D, Akın L, Aktaş D. Türk Hijyen ve Deneysel Biyoloji Dergisi. 2014;71(2):99-106
- Polat M, Parlak AH, Ors I, Sirmatel F. Erythema nodosum and Sweet’s sybdrome in patients with glandular tularemia. International Journal of Dermatology 2011; 50:866-69
- Gürbüz Y, Gülmez ZD, Tütüncü EE, Şencan İ: Bir Tularemil Pnömoni Olgusu. Klimik Dergisi 2019; 32:2010-12
- Matyas BT, Nieder HS, Telford SR. Pneumonic tularemia on Martha’s Vineyard: Clinical epidemiologic and ecological characteristic. Ann NY Acad Sci 2007; 1105:351-77
- Rimawi RH, Shah KB, Chowdhary RA, and Cook PP. Hunting for tularemia-A review of cases in North Carolina. Zoonoses Public Health 2015; 62:159-64
- Fachinger P, Tini GM, Grobholz R, Gambazzi F, Fankhauser H and Irani S. Pulmonary tularemia: All that looks like cancer is not necessarily cancer. Case report of four consecutive cases. BMC Pulm Med 2015; 15:1-6
- Gürcan Ş. Epidemiology of tularemia. Balkan Med J 2014; 31:3-10
- Sharma J, Mares CA, Li Q, Morris EG, Teale JM. Features of sepsis caused by pulmonary infection with Francisella tularensis Type A strain. Microb Pathog 2011; 51:39-47
- Ranjbar R, Behzadi P, Mammina C. Respiratory Tularemia; Francisella Tularensis and Microarray Probe Designing. Open Microbiol Journal 2016; 10:176-82
- Alias T, Fallahzadeh MK, Berhe M. Tularemia presenting as pulmonary nodules in an immuncompromised patient. Baylor Univ Med Cent Proc 2017; 30:175-76
- Naughton M, Brown R, Adkins D, Dipersio J. Tularemia. An unusual cause of a solitary pulmonary nodüle in the post-transplant setting. Bone Marrow Transplant 1999; 24:197-99
- Aktepe E, Sönmezer MC, Yarımoğlu S, Erdiç FS, Ertem G, Tülek N. Geç tanı konulan ülseroglandüler tularemi: Bir olgu sunumu. Klimik Der 2017; 30(2):83-6.
- Erzurumluoğlu N, Sargan A, Yildiz FR, Ozekinci S, Mersinlioglu G. A suppurative granulomatous lymphadenitis agent. Tularemia case report. Med J Okmeydanı Train Res Hosp 2018; 34:41-5
- Erdem H, Ozturk DE, Yesilyurt M. Et all. Evaluation of tularemia courses: A retrospective study from Turkey. Clin Microbiol Infect 2014; 20: 1042-51.
- Çelebi G. Klimik sayfası- https://www.klimik.org.tr/bilgi-merkezi/tularemi/tularemi-yrd-doc-dr-guven-celebi-zonguldak-karaelmas-universitesi-tip-fakultesi
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | August 31, 2020 |
| Submission Date | November 20, 2019 |
| Published in Issue | Year 2020 |