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An Overlooked Cause of Cervical Lymphadenopathy: Tularemia

Cilt: 36 Sayı: 2026 8 Ekim 2026
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An Overlooked Cause of Cervical Lymphadenopathy: Tularemia

Öz

Aim: Tularemia, a re-emerging zoonosis caused by Francisella tularensis, often presents as cervical lymphadenopathy in its oropharyngeal form, mimicking common infections. This clinical overlap leads to significant diagnostic delays and complications. We aimed to evaluate diagnostic delays, antibiotic use patterns, and clinical outcomes in patients with oropharyngeal tularemia presenting with cervical lymphadenopathy.
Materials and Methods: We retrospectively reviewed 22 patients admitted to our center in Konya, Türkiye, with cervical lymphadenopathy between January 2005 and January 2025. Diagnosis was confirmed by Microagglutination Test (MAT) titers ≥1/160. To ensure a homogenous cohort, patients with other clinical forms, equivocal serology, or alternative etiologies (e.g., tuberculosis, malignancy) were excluded. Statistical analyses were performed using IBM SPSS 26.0. Mann-Whitney U and Fisher’s exact tests were used to identify potential predictors of local complications. Ethical approval for the study was granted by the Necmettin Erbakan University Faculty of Medicine, Non-Drug and Medical Device Research Ethics Committee (Decision No: 2025/6243, Date: December 26, 2025).
Results: The mean age was 43.7 ± 16.4 years, with a female predominance (77.3%). Drinking untreated tap water was identified as a probable epidemiological risk factor in 72.7% of cases. The median diagnosticdelay was notably prolonged at 60 days (30–90), and among the 20 patients with available data, 75% (n=15) had received antibiotics before diagnosis. Local complications (suppuration/abscess) requiring surgical drainage occurred in 40.9% of patients. Statistical analysis revealed no significant correlation between clinical/laboratory parameters and the development of complications (p > 0.05). The most frequent treatment was doxycycline combined with streptomycin (40%).
Conclusions: Tularemia should be the primary differential diagnosis for long-standing, treatment-resistant cervical lymphadenopathy in endemic areas. Prolonged diagnostic delays and inappropriate beta-lactam use were common in this cohort and may contribute to preventable morbidity.

Anahtar Kelimeler

Francisella tularensis, lymphadenopathy, tularemia, zoonoses

Destekleyen Kurum

None.

Etik Beyan

Ethics committee approval was obtained for the study from the Necmettin Erbakan University Faculty of Medicine, Non-Drug and Medical Device Research Ethics Committee Presidency, with decision number 2025/6243, dated 26 December 2025.

Teşekkür

None.

Kaynakça

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  8. 8. Çelebi B, Kılıç S. Development of a novel Francisella tularensis antigen stained with tetrazolium-blue for tularemia microagglutination test. Mikrobiyol Bul 2013; 47(3):514-522.
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Kaynak Göster

APA
Kandemir, B., Belviranlı, P., Bulut, R., Kepenek Kurt, E., Genç, N., & Erayman, İ. (2026). An Overlooked Cause of Cervical Lymphadenopathy: Tularemia. Genel Tıp Dergisi, 36(2026), 1-6. https://doi.org/10.54005/geneltip.1892231
AMA
1.Kandemir B, Belviranlı P, Bulut R, Kepenek Kurt E, Genç N, Erayman İ. An Overlooked Cause of Cervical Lymphadenopathy: Tularemia. Genel Tıp Derg. 2026;36(2026):1-6. doi:10.54005/geneltip.1892231
Chicago
Kandemir, Bahar, Pınar Belviranlı, Rukiyye Bulut, Esma Kepenek Kurt, Nagehan Genç, ve İbrahim Erayman. 2026. “An Overlooked Cause of Cervical Lymphadenopathy: Tularemia”. Genel Tıp Dergisi 36 (2026): 1-6. https://doi.org/10.54005/geneltip.1892231.
EndNote
Kandemir B, Belviranlı P, Bulut R, Kepenek Kurt E, Genç N, Erayman İ (01 Ekim 2026) An Overlooked Cause of Cervical Lymphadenopathy: Tularemia. Genel Tıp Dergisi 36 2026 1–6.
IEEE
[1]B. Kandemir, P. Belviranlı, R. Bulut, E. Kepenek Kurt, N. Genç, ve İ. Erayman, “An Overlooked Cause of Cervical Lymphadenopathy: Tularemia”, Genel Tıp Derg, c. 36, sy 2026, ss. 1–6, Eki. 2026, doi: 10.54005/geneltip.1892231.
ISNAD
Kandemir, Bahar - Belviranlı, Pınar - Bulut, Rukiyye - Kepenek Kurt, Esma - Genç, Nagehan - Erayman, İbrahim. “An Overlooked Cause of Cervical Lymphadenopathy: Tularemia”. Genel Tıp Dergisi 36/2026 (01 Ekim 2026): 1-6. https://doi.org/10.54005/geneltip.1892231.
JAMA
1.Kandemir B, Belviranlı P, Bulut R, Kepenek Kurt E, Genç N, Erayman İ. An Overlooked Cause of Cervical Lymphadenopathy: Tularemia. Genel Tıp Derg. 2026;36:1–6.
MLA
Kandemir, Bahar, vd. “An Overlooked Cause of Cervical Lymphadenopathy: Tularemia”. Genel Tıp Dergisi, c. 36, sy 2026, Ekim 2026, ss. 1-6, doi:10.54005/geneltip.1892231.
Vancouver
1.Bahar Kandemir, Pınar Belviranlı, Rukiyye Bulut, Esma Kepenek Kurt, Nagehan Genç, İbrahim Erayman. An Overlooked Cause of Cervical Lymphadenopathy: Tularemia. Genel Tıp Derg. 01 Ekim 2026;36(2026):1-6. doi:10.54005/geneltip.1892231