Cervical abscess foci drainage in patients with oropharyngeal tularemia: clinical experience and treatment outcomes

BACKGROUND: Oropharyngeal tularemia often presents with suppurative cervical lymphadenopathy, in which necrotic tissue can hinder antimicrobial penetration. Despite established medical protocols, standardized criteria for surgical timing and associated factors of disease severity remain unclear. OBJECTIVES: We aimed to describe the clinical features of tularemia-related cervical abscesses, assess treatment responses, and identify factors predicting hospitalization. MATERIALS AND METHODS: We performed a retrospective study of 89 patients (microagglutination titer ≥1:160) between November 2023 and October 2024.Data included demographics, imaging, and outcomes, with ROC analysis used to identify prognostic indicators. RESULTS: The mean age was 41.9 ± 18.0 years; 61.8% of patients were female. Oropharyngeal tularemia predominated, with cervical swelling present in 84.3% of cases. Hospitalization was required for 50.6% of patients (median stay: 8 days). Due to suboptimal antibiotic response, 48.3% underwent surgical intervention. Male sex and a WBC count >7.9 × 109/L were independently associated with hospitalization. Inpatients showed higher leukocyte indices and a greater need for surgery. Among patients who underwent debridement or tissue sampling, necrotizing granulomatous inflammation may indicate more severe disease retrospectively. CONCLUSIONS AND SIGNIFICANCE: Cervical suppuration is a major cause of morbidity in oropharyngeal tularemia. Although medical therapy remains the primary treatment, timely surgical intervention is crucial in refractory cases to improve outcomes in endemic regions.