TULAREMIA AS A PEDIATRIC PROBLEM

[摘要] The results obtained, it would appear that the lack of any pathognomonic clinical feature, tardy appearance of specific agglutinins, and variations from the typical adult course render imperative a high index of suspicion if an early diagnosis of tularemia is to be made in a child. Careful questioning concerning possible ingestion of infected meats, animal contact or tick bite must be stressed. Involvement of siblings may be a strong point in favor of ingestional tularemia.Painstaking search for a local lesion should be made in every case with unexplained adenitis or appearance of sepsis; the frequency of pharyngo-tonsillar involvement must be appreciated. Usual laboratory aids may be of little value in early diagnosis in the average hospital or office at the present time. Early appearance of the heterophile cross-agglutination reaction may alert the observer to the possibility of tularemic infection.A severely ill patient, for whom a definitive diagnosis cannot be reached, failing to respond to therapy for other suspected illnesses, and in whom any of the factors just mentioned prevail, should receive the benefit of a therapeutic test with streptomycin. Favorable response and survival, as is true of effective antibiotic therapy for other acute illnesses, may permit of later retrospective diagnosis in some whose illnesses or deaths would otherwise have remained unexplained.

[学科分类] 儿科学