Fifteen-year study maps tularemia in children with swollen neck lymph nodes

Children living in an endemic region of Turkey who develop persistent swollen lymph nodes in the neck may have tularemia, and a new retrospective study suggests that a combination of simple clinical and ultrasound features can help distinguish the disease from other causes of cervical lymphadenopathy.

The study, conducted at a tertiary referral center in Sivas Province between 2011 and 2025, included 71 pediatric patients evaluated for suspected tularemia. Of these, 31 were classified as tularemia positive and 40 served as controls, based on microbiological and serological criteria. The researchers compared demographic, clinical, laboratory, and radiological data, along with treatment approaches and outcomes, between the two groups.

Rural residence emerged as a significant risk marker, reported in 80.0 percent of children with tularemia compared with 55.0 percent of controls, a difference the authors reported as statistically significant. This pattern reflects the disease’s known epidemiology in endemic regions, where exposure is linked to rural living conditions.

Several imaging and clinical findings favored a diagnosis of tularemia. Submandibular lymphadenopathy was present in 60.7 percent of tularemia cases versus 34.7 percent of controls, nodal necrosis in 25.8 percent versus 2.5 percent, and hypoechoic lymph nodes on ultrasound in 30.0 percent versus 10.0 percent. In contrast, conglomerated lymph nodes were more common among children who did not have tularemia, appearing in 47.5 percent of controls compared with 17.2 percent of tularemia patients. All of these differences reached statistical significance.

Laboratory profiles also differed between the groups. Children with tularemia had higher leukocyte, neutrophil, and lymphocyte counts, higher platelet counts, and higher erythrocyte sedimentation rate levels, while their albumin concentrations were lower. Each of these differences was statistically significant, according to the study results.

The treatment history of the patients highlighted a common diagnostic delay. Before tularemia was recognized, beta-lactam antibiotics had been prescribed in 74.2 percent of cases, whereas after diagnosis the most frequently administered antimicrobial agents were aminoglycosides, given to 64.5 percent of patients. The authors note that delayed diagnosis may lead to prolonged morbidity, inappropriate antibiotic use, and unnecessary invasive procedures.

Surgical intervention was required in more than half of the tularemia patients, at 58.1 percent. The study’s conclusion states that early recognition and appropriate antimicrobial therapy may reduce the need for surgery, although as a retrospective observational analysis the study cannot establish that earlier treatment would definitively lower surgical rates.

Among the children in whom tularemia was excluded, reactive lymphadenopathy accounted for 60 percent of final diagnoses, followed by Epstein-Barr virus-associated lymphadenopathy at 12.5 percent, making these the most common alternative diagnoses in the control group.

The authors conclude that tularemia should be considered in children with cervical lymphadenopathy and oropharyngeal symptoms in endemic regions, particularly those living in rural areas. They suggest that submandibular involvement, necrotic and hypoechoic lymph nodes, and a lower tendency for lymph nodes to conglomerate may help clinicians distinguish tularemia from other causes of swollen neck lymph nodes.

As a single-center retrospective study from one endemic province, the findings describe the clinical experience of one referral center over 15 years and identify features associated with confirmed tularemia in this pediatric population. The study was published as an open-access research article in BMC Pediatrics.

Subject of Research: Clinical features and outcomes of pediatric tularemia in an endemic region of Turkey

Article Title: Tularemia in pediatric patients in Sivas Province: a 15-year clinical experience

Article References: Kılınç, S., Korğalı, E. Ü., Çelik, N., Maraşlı, H., Özçelik, G., Bayrak, Ö., Tan, A. K., İnci, F., & Baspinar, N. (2026). Tularemia in pediatric patients in Sivas Province: a 15-year clinical experience. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07597-6

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07597-6

Keywords: tularemia, pediatrics, cervical lymphadenopathy, Sivas Province, retrospective study, submandibular lymphadenopathy, aminoglycosides, ultrasound, rural residence, BMC Pediatrics, infectious disease, diagnostic delay