Generalized form of tularemia in pediatric surgeon practice: Difficulties of diagnosis and treatment

Abstract

Tularemia in the practice of a pediatric surgeon is a rare disease, and abdominal and generalized forms of it are not detected without specific laboratory diagnostics. The long-term serious condition of patients, intoxication, abdominal pain with excluded acute surgical pathology in children force differential diagnosis with rare infectious diseases, including tularemia. In the Russian Federation, up to 30 children a year are diagnosed with tularemia, with the exception of outbreaks of the disease in some years. At the same time, the generalized form is detected in no more than 10% of patients. The authors presented a clinical case of a generalized form of tularemia in a 17-year-old patient. The disease started with abdominal pain, diarrhea and vomiting. At the beginning of the disease, a diagnostic error was made — suspicion of ovarian inversion and laparotomy according to Pfannenstiel. In the further development of the disease, pronounced ascites were detected with the production of up to 5 liters of effusion per day, damage to the kidneys, liver, heart, gastrointestinal tract. Laboratory data revealed leukocytosis up to 89×109, accelerated erythrocyte sedimentation rate, increased levels of creatinine, urea, transaminases, C-reactive protein, proteinuria persisted for a long time. Indirect hemagglutination reaction with tularemia diagnosticum made it possible to establish the diagnosis of tularemia, generalized form. During two weeks of the disease, an 8-fold increase in the titer of antibodies was noted. Syndrome therapy and specific antibacterial therapy made it possible to stop the infectious process and discharge the patient home on the 44th day of the illness with recovery.