Cervical lymph node swelling is found in many different disciplines from general medicine to specialized disciplines such as otorhinolaryngology or craniomaxillofacial surgery. Reasons for the swelling might be benign or malign diseases. Benign swellings or even abscesses as a result of infections are mostly caused by
Staphylococcus aureus and group A streptococcus. A rare zoonotic disease also causing lymph node swelling is tularemia. This disease appears all over the northern hemisphere but the incidence of only 1056 cases recorded in the European Union in 2016 is quite low [
1].
Francisella tularensis, the pathogen of tularemia, is a Gram-negative bacterium; it was first described in 1911 in the United States of America (USA). The bacterium can be divided into four different subspecies. The subspecies
F.
tularensis subspecies
holarctica is mostly prevalent in Europe whereas the subspecies
F.
tularensis subspecies
tularensis is most frequently found in North America [
2]. Although the bacterium itself could be identified in more than 250 different animal species, the exact transmission path to humans is not quite clear yet. One possible path of infection beside infection through wild animals seems to be transmission through mosquitos [
3]. Another possible way could be infection through fruit, such as the recently described transmission path of freshly pressed grape must [
4]. Two different forms of clinical appearance must be distinguished: a localized (outer) and a systemic (inner) form. The most obvious form in Europe is the outer form here represented by the so-called ulceroglandular disease. After an incubation time of 3 to 5 days nonspecific systemic symptoms such as fever, chills, anorexia, and malaise appear; the portal of entry presents as a single ulcerative lesion with a central eschar. Sometimes this lesion is not visible due to location in the hair. At the same time or a little later, regional lymph node swelling or even lymph node abscesses occur. Known complications without adequate treatment are persisting lymph node swelling with fever attacks at night, meningitis, or even organ damage, for example of the kidneys or the heart. Depending on the subspecies of infection, mortality rates vary a lot; whereas infections with
F.
tularensis subspecies
holarctica show a low mortality rate, this rate increases up to 30% in infections caused by
F.
tularensis subspecies
tularensis if no sufficient treatment ensues [
5]. In order to avoid serious illness and complications, early adequate treatment after identification of the pathogen is necessary. Effective antibiotic substances are aminoglycosides, fluoroquinolones, tetracycline, chloramphenicol, and rifampicin. Erythromycin as representative of the macrolides should not be used due to the natural resistance especially of the
F.
tularensis subspecies
holarctica [
6]. Drainage is an additional and urgently needed treatment especially when abscesses are obvious.