How to suspect tularemia in a child outside the endemic focus

Tularemia is an acute zoonotic natural focal disease caused by Francisella tularensis, with a variety of pathogen transmission mechanisms. A person becomes infected in various ways, mainly through insect bites (mosquitoes, ticks), through direct contact with infected animals, and also by inhalation. The disease is characterized by high fever, intoxication, inflammatory changes in the area of the entrance gate, regional lymphadenitis. It is often difficult to suspect tularemia in the early stages due to the lack of specificity of clinical manifestations (fever, intoxication, regional lymphadenitis). Even in endemic regions, in most cases, acute respiratory viral infection, lymphadenitis, fever of unknown origin are diagnosed, which leads to a late start of etiotropic treatment. There is a clinical case of tularemia in a 13-year-old child who was misdiagnosed in the early stages of the disease. And only a careful collection of an epidemiological history (stay in an endemic area, a mosquito bite), as well as a competent assessment of clinical and laboratory data, allowed tularemia to be included in the differential diagnosis on the 18^th day of the disease and confirmed by the detection of the highest titers of anti-tularemia antibodies in blood serum. Thus, against the background of low morbidity, especially in childhood, there is no alertness among doctors of all specialties, which leads to late diagnosis and, as a consequence, late started specific treatment. All children with prolonged fever in the presence of lymphadenitis of unknown genesis, who have been in a territory unfavorable for tularemia, need to undergo a specific examination to identify mild and erased forms of the disease.