Tularemia of the head and neck in the pediatric population – a review and recommendations for otorhinolaryngological practice

Introduction: Tularemia, a zoonosis caused by the Gram-negative bacterium Francisella tularensis, is a serious threat to public health. The disorder can take the ulceroglandular, pneumonic, oropharyngeal, oculoglandular, gastrointestinal, or typhoidal forms. Infection occurs through contact with infected animals, tick/insect bites, or inhalation of contaminated aerosols. The clinical presentation of tularemia may vary; the condition is often confused with streptococcal pharyngitis, infectious mononucleosis, or other diseases. Aim: The aim of this paper is to systematize the knowledge on tularemia in the context of ENT practice, to discuss the recommended treatment, and to present typical clinical presentations. Material and methods: A review of the literature published in the years 2000–2025 as available through the PubMed database was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Demographic data and information on the clinical course, source and routes of infection, as well as complications and treatment, were extracted for analysis. Results: The database query returned a total of 178 papers; of these, 12 articles describing 25 children were finally qualified for the review. The results, as reported for children aged 8 months–17 years, were divided into 3 groups depending on the variant of tularemia, namely oropharyngeal tularemia, ulceroglandular tularemia, or tularemia of the middle ear. Oropharyngeal tularemia and ulceroglandular tularemia were the most predominant variants. The main vectors were rodents and ticks. The most common symptoms included fever, sore throat, enlarged lymph nodes, and skin lesions. Conclusions: Despite being well described in the literature, tularemia remains rarely diagnosed in most Central European countries. Early diagnosis and prompt management are key to preventing severe complications. The best therapeutic results are obtained using antibiotics from the group of fluoroquinolones, tetracyclines, or aminoglycosides. The recommended duration of antibiotic therapy is 14–21 days.