[Successful Treatment of Glandular Tularemia with Azithromycin in a Pregnant Patient and Literature Review].

Tularemia is a zoonosis caused by the bacterium Francisella tularensis. F.tularensis is a small pleomorphic, non-motile, obligate aerobe, gram-negative bacterium that shows facultative intracellular parasitism. It is known to cause disease in both humans and animals and is one of the most infectious bacteria known. The disease has different clinical forms depending on the route of bacterial entry into the body. The routes of transmission of the disease include drinking water contaminated with the bacteria, tick bites, consuming game meat, handling tissues or fluids from infected animals and inhaling infected aerosols. While there is a potential for pregnant animals to miscarry, the frequency of this risk in humans remains uncertain due to the low number of tularemia cases during pregnancy. F.tularensis has four subspecies, which differ in virulence and geographical distribution. The subspecies found in Türkiye is F.tularensis subspecies holarctica, which has a better clinic. In the treatment of tularemia, aminoglycosides (streptomycin, amikacin), quinolones and tetracyclines are used. However, due to the fetotoxicity of these agents, their use during pregnancy is problematic. The World Health Organization recommends using gentamicin or ciprofloxacin for the treatment of tularemia during pregnancy. In this case report, tularemia infection that developed in the second trimester of pregnancy was presented and the relevant literature was reviewed., A 23-year-old patient in the 16th week of her pregnancy presented with painful swelling in the neck. Following the detection of a microagglutination test titer of over 1/1280 for tularemia in her blood sample sent to General Directorate of Public Health National High Risk Pathogens Reference Laboratories, the patient was diagnosed as tularemia. Gentamicin treatment was planned for the patient who had glandular tularemia however, due to the refusal of this treatment by the patient and her relatives, oral azithromycin (500 mg/day for six weeks) was initiated instead. The patient was closely monitored with clinical, laboratory findings, and obstetric ultrasonography until delivery. A complicationfree birth occurred at the 39th week of pregnancy. Postnatal follow-up for two months revealed that both the mother and the baby were in good health. A PubMed search using the keywords “tularemia, pregnancy, azithromycin” identified case reports from three different countries (Austria, France and the United States of America) in which tularemia cases during pregnancy were successfully treated with azithromycin. To our knowledge, the presented case is the fourth case successfully treated with azithromycin in the literature. While tularemia cases during pregnancy have previously been reported in Türkiye, this case report represents the first documented experience with the use of azithromycin for the treatment within the country.