[Tularemia in Belgium : A zoonotic disease more common than you might think].

Tularemia, a zoonosis caused by Francisella tularensis, is highly virulent and classified as a category A bioterrorism agent. Although rare in Belgium, tularemia is likely underdiagnosed, due to its frequent unfamiliarity among clinicians. This article reports two cases treated at the University Hospital of Liège. The first case involves a 61-year-old man presenting with oropharyngeal symptoms and cervical lymphadenopathy, diagnosed after the failure of conventional antibiotic treatments and confirmed by PCR. The second case concerns a 70-year old woman with systemic symptoms and mediastinal lymphadenopathy, initially suspected to be neoplastic, before tularemia was confirmed by serology and PCR. Without treatment, tularemia can become chronic and debilitating, and lead to complications such as suppuration of lymph nodes. Besides describing the two clinical cases, we will cover the epidemiology, diagnosis, and treatment of the disease. Early recognition of tularemia remains challenging due to the lack of awareness among clinicians and the diverse clinical manifestations of the disease.