A single-center study of a waterborne tularemia outbreak among adults and children in Turkiye

PURPOSE: Tularemia is a zoonotic disease that can cause both sporadic cases and outbreaks. This study aims to analyze a waterborne tularemia outbreak in eastern of Turkiye during January and February 2025 and to evaluate adult and pediatric tularemia patients, highlighting the differences and similarities between the two patient populations. METHODS: The study included patients who presented to Malazgirt State Hospital during the tularemia outbreak and were diagnosed with tularemia. Data on age, gender, clinical and laboratory findings, antibiotic regimens/durations and complications were collected and analyzed. RESULTS: The study included 56 participants (mean age 24.6 ± 20.5 years, 44% female, 51% adult). No significant difference was found in the distribution of tularemia type between adult and pediatric patients (p = 0.198); the predominant type in both groups was the oropharyngeal form. Lymphadenopathy (LAP) was more frequent in adult patients (p < 0.05), abdominal pain was more frequent in pediatric patients (p < 0.001), and no significant differences were found in other clinical findings. Leukocytosis was significantly more frequent in pediatric patients compared to adults (p = 0.016). Treatment duration was statistically significantly longer in adult patients compared to pediatric patients (p < 0.001). One of the patients was pregnant who was treated with azithromycin and a healthy delivery was achieved. There were no cases resulting in sepsis or death. CONCLUSIONS: Our study demonstrated that tularemia can cause different clinical presentations in adult and pediatric patient groups. Despite this clinical diversity, we emphasized the critical role of recognizing the common transmission route and source in epidemic control.