Tularemia是一种由革兰阴性球菌引起的人畜共患的细菌传染病。在人类中,疾病导致几种不同的临床形式(溃疡性,腺体,眼腺,呼吸,伤寒和口咽)。由于该疾病在Türkiye传播给人类的主要方式是通过饮用受F.tularensis污染的水,口咽部形式是最常见的临床表现。因为怀孕的塔拉热症病例很少见,关于母胎和母胎并发症的文献很少。在这份报告中,介绍了1例模仿淋巴瘤在怀孕期间的口咽部突症。住在锡瓦斯省一个村庄的一名33岁的11周怀孕患者因颈部肿胀而进入传染病和临床微生物学门诊,持续了六天。病人,从事畜牧业的她说,她食用原料奶,并于10天前因发烧而入院于一家医院的耳鼻喉科门诊,发冷,喉咙痛.她说,她的投诉没有因为医生建议的阿莫西林-克拉维酸治疗而消退,她注意到在治疗的第4天颈部肿胀。经进一步询问,据了解,该患者有食用未氯化泉水的病史。她的生命体征正常,体格检查显示右颈后区淋巴结无波动,最大为5x2cm。左侧为3x2厘米。实验室测试显示血液白细胞计数为13.32x103/mm3(75%粒细胞),血液血红蛋白为11.4g/dL,45毫米/小时的红细胞沉降率,C反应蛋白90mg/L非对比MRI检查显示鼻咽壁增厚和淋巴结肿大,可疑为淋巴瘤,在扩散加权图像上存在明显的扩散限制。由于过去的病史和临床发现提示了兔热病,研究了微凝集试验(MAT),但报告为阴性,滴度为1/80。由于患者的投诉持续,并且在过去几年中在我们地区遇到了暴aremia病例,两周后重复的MAT报告为阳性,滴度为1/320.诊断为口咽形式的tularemia,并从第14孕周开始口服环丙沙星(2x750mg),持续三周。通过对患者颈部淋巴结进行细针穿刺活检的组织病理学检查排除淋巴瘤,但活检样本与肉芽肿性疾病相符.喉和鼻咽的诊断性活检的组织病理学发现是反应性的。一个健康的男婴,2425克,47厘米,在妊娠第37周出现分娩收缩的患者通过剖宫产分娩。新生儿没有先天性感染的迹象。患者和婴儿随访至1年,未发现异常。对包括此案在内的文献中报告的17例病例的评估,建议在怀孕期间,tularemia可能进展为涉及严重的产科并发症,比如堕胎,早产和宫内胎儿死亡时,不给予适当和有效的抗生素治疗。
Tularemia is a zoonotic bacterial infectious disease caused by a gram-negative coccobacillus namely Francisella tularensis. In humans, disease leads to several different clinical forms (ulceroglandular, glandular, oculoglandular, respiratory, typhoidal and oropharyngeal). Since the main mode of transmission of the disease to humans in Türkiye is by drinking water contaminated with F.tularensis, the oropharyngeal form is the most common clinical manifestation. Since tularemia cases with pregnancy are rare, the literatüre about maternal and fetal complications of tularemia is sparse. In this report, a
case of oropharyngeal tularemia mimicking lymphoma during pregnancy was presented. A 33-year-old 11-week pregnant patient living in a village in Sivas province admitted to the infectious diseases and clinical microbiology outpatient clinic with the complaint of swelling in the neck region that continued for six days. The patient, who was engaged in animal husbandry stated that she consumed raw milk and admitted to the otorhinolaryngology outpatient clinic of a hospital 10 days ago with the complaints of fever, chills, and sore throat. She stated that her complaints did not regress with the amoxicillin-clavulanate treatment recommended by her doctor and she noticed the swelling in her neck on the 4th day of the treatment. Upon further questioning, it was understood that the patient had a history of consumption of unchlorinated spring water. Her vital signs were normal and physical examination revealed non-fluctuant lymph nodes with the largest of 5 x 2 cm in the right posterior cervical region, and 3 x 2 cm in the left. Laboratory tests revealed a blood leukocyte count of 13.32 x 103/mm3 (75% granulocytes), a blood hemoglobin of 11.4 g/dL, an erythrocyte sedimentation rate of 45 mm/hour, and C-reactive protein of 90 mg/L. A non-contrast MRI examination revealed wall thickening of the nasopharynx and enlarged lymph nodes which were suspicious for lymphoma with significant diffusion restriction on diffusionweighted images. As the past medical history and clinical findings were suggestive for tularemia, the microagglutination test (MAT) was studied, but it was reported as negative with a titer at 1/80. Since the patient\'s complaints continued and tularemia cases were encountered in our region in the past years, the repeated MAT after two weeks was reported as positive with a titer at 1/320. An oropharyngeal form of tularemia was diagnosed and oral ciprofloxacin (2 x 750 mg) was given for three weeks by starting at the 14th gestational week. Lymphoma was excluded by histopathological examination of the fine needle aspiration biopsy performed on the patient\'s cervical lymph nodes, but the biopsy sample was compatible with granulomatous diseases. Histopathological findings of diagnostic biopsies of the larynx and nasopharynx were reactive. A healthy male baby, 2425 grams, 47 cm, was delivered by cesarean section from the patient who presented with labor contractions at the 37th week of pregnancy. There was no sign of congenital infection in the newborn. The patient and the baby were followed up to the end of one year and no abnormality was found. The evaluation of 17 cases reported in the literatüre including this
case, suggest that tularemia may progress to involve serious obstetric complications during pregnancy, such as abortion, premature birth and intrauterine fetal death when appropriate and effective antibiotic treatment is not given.