Eren Gok Sebnem, Kocagul Celikbas Aysel, Baykam Nurcan, Atay Buyukdemirci Ayse, Eroglu Mustafa Necati, Evren Kemer Ozlem, Dokuzoguz Basak
Ankara Numune Training and Research Hospital, Ankara, Turkey.
J Infect Dev Ctries. 2014 Oct 15;8(10):1277-84. doi: 10.3855/jidc.3996.
Tularemia is a zoonotic disease caused by Francisella tularensis. The oculoglandular form is one of the rarest forms. In this study, evaluated tularemia patients, focusing on the ocular form and the efficacy of early antibiotic therapy.
During a tularemia outbreak, the epidemiological and clinical findings, laboratory assays, and drugs used for the treatment of 48 patients were recorded prospectively. The diagnosis of tularemia was confirmed with microagglutination test (MAT) as well as clinical findings.
The mean age of the subject was 48.6 years; 23 (47.9%) of them were female. Thirty-six (81.25%) patients had clinical presentation compatible with oropharyngeal tularemia, seven (14.58%) with oculoglandular tularemia, and two (4.1%) with ulceroglandular tularemia. The most common symptoms were fever (91.6%) and sore throat (81.2%), and the most common findings were lymphadenopathy (91.6%) and tonsillopharyngitis (81.2%). In the oculoglandular form, fever, lymphadenopathy, periorbital edema, conjunctival injection, and chemosis were found. The most distinctive ophthalmic feature was follicular conjunctivitis and conjunctival epithelial defects. Forty-five cases had positive serological results with MAT. All the patients were treated with antibiotics considered effective against F. tularensis, and topical antimicrobial treatment was given to the patients with oculoglandular tularemia. Twenty-six (54.16%) patients, who were admitted within three weeks of the onset of symptoms, recovered without sequel.
During tularemia outbreaks, ocular involvement should be considered carefully. The early administration of appropriate treatment will be more effective in resolving the infection and preventing complications. Along with systemic antibiotic therapy, topical treatment will help recovery.
兔热病是由土拉弗朗西斯菌引起的一种人畜共患病。眼腺型是最罕见的类型之一。在本研究中，对兔热病患者进行了评估，重点关注眼型及早期抗生素治疗的疗效。
在一次兔热病暴发期间，前瞻性记录了48例患者的流行病学和临床发现、实验室检测结果以及治疗所用药物。兔热病的诊断通过微量凝集试验（MAT）及临床发现得以证实。
受试者的平均年龄为48.6岁；其中23例（47.9%）为女性。36例（81.25%）患者的临床表现符合口咽型兔热病，7例（14.58%）为眼腺型兔热病，2例（4.1%）为溃疡腺型兔热病。最常见的症状是发热（91.6%）和咽痛（81.2%），最常见的体征是淋巴结病（91.6%）和扁桃体咽炎（81.2%）。在眼腺型中，发现有发热、淋巴结病、眶周水肿、结膜充血和结膜水肿。最具特征性的眼部表现是滤泡性结膜炎和结膜上皮缺损。45例患者的血清学检测结果呈MAT阳性。所有患者均接受了被认为对土拉弗朗西斯菌有效的抗生素治疗，眼腺型兔热病患者还接受了局部抗菌治疗。26例（54.16%）在症状出现后三周内入院的患者康复且无后遗症。
在兔热病暴发期间，应仔细考虑眼部受累情况。早期给予适当治疗对解决感染和预防并发症将更有效。除全身抗生素治疗外，局部治疗将有助于康复。
