Clinical factors associated with invasive intervention and outcomes of drainage in pediatric tularemia.

UNLABELLED: Tularemia is an important zoonotic infection in endemic regions, and delayed diagnosis may be associated with suppurative lymphadenitis and need for invasive intervention. Although antimicrobial therapy remains the cornerstone of treatment, the optimal management of suppurative lymphadenitis remains uncertain. This study aimed to characterize pediatric tularemia and evaluate treatment outcomes, with particular emphasis on drainage-based management of suppurative lymphadenitis. This retrospective, single-center study included children with laboratory-confirmed tularemia. Demographic, clinical, laboratory, and management characteristics were collected from medical records. Clinical characteristics and outcomes were compared between children who underwent invasive intervention and those managed with antimicrobial therapy alone. Invasive intervention included fine-needle aspiration, drain placement, or excisional biopsy. Four children who underwent excisional biopsy before tularemia diagnosis and referral were excluded from this comparison, leaving 22 children in the intervention group and 16 in the antimicrobial therapy-only group. A total of 42 children were included; 27 (64.3%) were male, and the median age was 13.7 years (IQR, 9.3-16.0). Oropharyngeal tularemia was the predominant clinical form (n = 37, 88.1%), and suppurative lymphadenitis was identified in 28 (66.7%). Overall, 26 children (61.9%) underwent a procedural intervention. Children undergoing intervention had a longer interval from symptom onset till final diagnosis than those managed conservatively with antibiotics only (median, 8 vs. 4 weeks; median difference, 4 weeks; 95% CI, 0.0-5.0; p = 0.040). Drain placement was performed in 16 children (38.1%) for a median of 3 days (IQR, 3-4). None required repeated drainage, further procedural intervention, or subsequent lymph node excision. All children achieved complete clinical recovery during a median follow-up of 2.0 months (IQR, 1.0-4.0). CONCLUSIONS: A delayed time interval from symptom onset till diagnosis was associated with need for invasive intervention in children with tularemia. Early drainage was followed by favorable outcomes, with no repeated procedures or subsequent lymph node excision. These findings highlight the importance of early diagnosis and suggest that timely drainage may provide an effective source-control approach in selected children with suppurative tularemia lymphadenitis. WHAT IS KNOWN: • Delayed diagnosis of pediatric tularemia may lead to suppurative lymphadenitis and the need for invasive intervention. • The optimal invasive intervention of suppurative tularemia lymphadenitis in children remains unclear. WHAT IS NEW: • Short-term drainage of suppurative tularemia lymphadenitis resulted in favorable outcomes without repeated drainage or subsequent lymph node excision. • Drainage may provide an effective, tissue-preserving source-control approach in selected children with established suppurative disease.