Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review

Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.

Automated summary

Although Francisella tularensis is a well-known zoonotic pathogen, its importance in Central Europe is relatively minor. However, the annual incidence of tularaemia is higher in the Czech Republic compared to neighboring countries. The common mode of transmission in Central Europe is through handling infected animals, rather than tick bites. This study reports two rare cases of tick bite-associated ulceroglandular tularaemia in young children, indicating possible changes in the epidemiology of tularaemia in the Czech Republic.