Şenel Engin, Satılmış Özgür, Acar Bilal
Department of Dermatology, Hitit University Faculy of Medicine, Çankırı State Hospital, Çankırı, Turkey.
Int J Dermatol. 2015 Jan;54(1):e33-7. doi: 10.1111/ijd.12431. Epub 2014 Sep 10.
Tularemia is a serious and potentially life-threatening zoonosis caused by Francisella tularensis, a highly infective, gram-negative coccobacillus. Although there are plenty of case reports and studies of tularemia outbreaks, the literature is lacking in reports on dermatologic manifestations of the disease.
This study aimed to identify skin manifestations in clinical forms of tularemia.
A total of 151 patients diagnosed with tularemia at Çankırı State Hospital, Çankırı, Turkey, were retrospectively examined. Dermatologic data for these patients were assessed.
The most frequent clinical manifestation of tularemia was the glandular form (49.7%), followed by the oropharyngeal, ulceroglandular, and oculoglandular forms (39.1, 6.0, and 5.3%, respectively). Physical manifestations were observed in 64.5% of females and 56.9% of males. Lymphadenopathy and tonsillitis were the most frequent physical findings and were noted in 57.6 and 25.2% of patients, respectively. Erythema multiforme was found in 17 patients (11.3%), most of whom presented with the oropharyngeal and glandular forms, and was followed by ulcer (6.0%), urticaria (3.3%), erythema nodosum (2.6%), and cellulitis (0.7%). However, it should be noted that this study was retrospective and that its patient sample demonstrated four of the six clinical forms of tularemia.
Patients with the oropharyngeal form of tularemia had statistically significantly more physical findings than those with other clinical forms of the disease (P < 0.001). There were statistically more skin findings in the ulceroglandular form (P < 0.001). There was no statistical correlation between serum antibody titers and cutaneous findings (P = 0.585). Although the literature reports that skin lesions are observed more frequently in women than in men, we did not find any statistically significant difference between the sexes in any type of skin lesion.
兔热病是由土拉弗朗西斯菌引起的一种严重且可能危及生命的人畜共患病，土拉弗朗西斯菌是一种高传染性的革兰氏阴性球杆菌。尽管有大量关于兔热病暴发的病例报告和研究，但该疾病皮肤表现的报道却很缺乏。
本研究旨在确定兔热病临床类型中的皮肤表现。
对土耳其昌基尔市昌基尔州立医院确诊的151例兔热病患者进行回顾性检查。评估这些患者的皮肤学数据。
兔热病最常见的临床表现为腺型（49.7%），其次是口咽型、溃疡腺型和眼腺型（分别为39.1%、6.0%和5.3%）。64.5%的女性和56.9%的男性出现了身体表现。淋巴结病和扁桃体炎是最常见的身体检查结果，分别在57.6%和25.2%的患者中出现。17例患者（11.3%）出现多形红斑，其中大多数为口咽型和腺型，其次是溃疡（6.0%）、荨麻疹（3.3%）、结节性红斑（2.6%）和蜂窝织炎（0.7%）。然而，应该注意的是，本研究是回顾性的，其患者样本显示了兔热病六种临床类型中的四种。
口咽型兔热病患者的身体检查结果在统计学上显著多于其他临床类型的患者（P < 0.001）。溃疡腺型的皮肤表现统计学上更多（P < 0.001）。血清抗体滴度与皮肤表现之间无统计学相关性（P = 0.585）。尽管文献报道女性比男性更频繁地观察到皮肤病变，但我们未发现任何类型的皮肤病变在性别之间存在统计学上的显著差异。
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