1479Evaluation of Tularemia Courses: A Multicenter Study From Turkey

Background. In this multicentric study, which is the largest case series ever reported, we aimed to describe the features of tularemia to provide detailed information. Methods. This multi-center study pooled patients with any form of tularemia from 41 medical centers in Turkey. The study had a retrospective design and included patients treated between 2000 and 2013. No control groups were included for this study. Fatih Sultan Mehmet Training and Research Hospital’s Review Board in Istanbul approved the study. Results. Before the definite diagnosis of tularemia, tonsillitis (n = 653, 63%) and/ or pharyngitis in (n = 146, 14%) were the most frequent the preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1), oculoglandular (n = 105) forms. In 987 patients (95.5 %) the lymph nodes were reported to be enlarged, most frequently at the cervical chain [ jugular (n = 599, 58%), submandibular (n = 401, 39%) periauricular (n = 55, 5%)]. Ultrasound imaging has shown hyperechoic and hypoechoic patterns (59% and 25% respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with beta lactam-beta lactamase inhibitors (n = 793, 76%). Anti-tuberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularemia after the start of symptoms with a mean of 26.8 ± 37.5 days. Treatment failure was considered in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite two weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. Conclusion. In conclusion, tularemia is a long lasting, but a curable disease in this part of the world. However, the treatment strategy still needs optimization. Disclosures. All authors: No reported disclosures.