G2-1317. Tularemia: Retrospective Review of Ten Years Experience in Arkansas
Session: Poster Session: Pediatrics II
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Tularemia is a zoonotic disease caused by Francisella tularensis. It is reported more commonly in Arkansas than most other states. The purpose of this study is to review all cases of tularemia among inpatients at Arkansas Children’s Hospital (ACH) from 1996-2006 to evaluate clinical presentation, diagnosis and treatment. Methods: Records of the Infectious Disease Section were reviewed to identify cases of suspected or proven tularemia for further study. Results: 30 cases of tularemia were diagnosed among inpatients at ACH. Ages ranged in 18 months to 14 years, with equal male:female distribution. 73% were diagnosed in summer months. 90% reported a tick bite prior to onset of symptoms. Seventeen patients (57%) presented with ulceroglandular tularemia, including one patient who also had pneumonia and meningitis. The remaining patients presented with glandular disease. Fever was present prior to admission in 90%. Most patients had been ill for 10-14 days prior to admission and were evaluated at least once by another physician, with 71% receiving antibiotics for disease other than tularemia during their illness. Serology was positive in 77%, although several had positive serology only on convalescent studies. Seven patients ultimately required surgical drainage of infected lymph nodes after treatment had been initiated. Most patients (96%) were treated with gentamicin (6-14 days) and responded well. Three patients had recurrent disease, including one patient initially treated with ciprofloxacin alone. All 3 patients ultimately resolved their infection with further antibiotics and drainage. Conclusions: This series emphasizes the importance of tularemia as an early diagnostic consideration among children with fever and lymphadenopathy in Arkansas, particularly in summer months. Convalescent serology is an important diagnostic tool, as many patients will remain seronegative for the first 7-14 days of illness. Gentamicin remains a highly effective treatment and should be considered first-line therapy for suspected tularemia.
Jessica Nichols, MD, University of Arkansas for Medical Sciences, Little Rock, AR, Stephanie Stovall, MD, Arkansas Children's Hospital, Little Rock, AR and  J. R. Nichols, None.

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