October 1990

Tonsillopharyngeal Tularemia: A Reminder

Author Affiliations

Hematology-Oncology Division
Infectious Disease Division Department of Pediatrics University of Oklahoma Health Sciences Center and Children's Hospital of Oklahoma PO Box 26901 Oklahoma City, OK 73190

Am J Dis Child. 1990;144(10):1070-1071. doi:10.1001/archpedi.1990.02150340012007

Sir.—Exudative tonsillopharyngitis is a common illness of childhood, usually caused by group A streptococcus or a virus (eg, Epstein-Barr, adenovirus). Clinical differentiation may be difficult, even impossible. Rarely do other agents cause this disease. Streptococcus pyogenes antigens rapidly detected in the throat by culture are usually diagnostic. A viral cause is not as readily established and studies are not routinely performed. Occasionally, patients whose tonsillopharyngeal infection is caused by other bacterial agents can be treated. As a reminder of this, we describe a boy with an intractable pharyngeal infection that proved to be tonsillopharyngeal tularemia.

Patient Report.—A 2½-year-old white boy was transferred to the Children's Hospital of Oklahoma, Oklahoma City, from another hospital where he was admitted 2 days previously. He had a 3-day history of fever, sore throat, submandibular adenopathy, and poor oral intake. Laboratory investigations included a rapid diagnostic test that yielded normal results for

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