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Lindgren H, Liu X, Sjöstedt A. Francisella tularensis-specific antibody levels in sera from Swedish patients with suspected tularemia during a 13-year period. Front Cell Infect Microbiol 2024; 14:1381776. [PMID: 38628552 PMCID: PMC11018962 DOI: 10.3389/fcimb.2024.1381776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction For a majority of tularemia patients, serology is the basis for the diagnosis. The aim of this study was to perform an analysis of the samples analyzed at a Swedish reference laboratory for the presence of Francisella tularensis-specific antibody levels in sera from individuals with suspected tularemia. Annual and monthly variations of the total number of samples and proportions of positive samples were analyzed, as well as the influence of age and gender. Methods We performed a retrospective analysis of the presence of F. tularensis-specific antibodies in serological samples from patients with suspected tularemia analyzed during the period 2010 - 2022 at the University Hospital of Umeå in Sweden, a national reference laboratory, by use of various statistical methods. In total, some 15,100 serum samples had been analyzed for the presence of IgG and IgM antibodies by ELISA during the 13-year period. Results Overall, there were higher number of samples with IgG positive or borderline titers, 2,522 and 921, respectively, than with IgM positive or borderline titers, 1,802 and 409, respectively. Repeated samples were obtained from some 1,930 individuals and approximately a third of the cases, which were initially seronegative, had seroconverted when resampled. Peak number of monthly samples were recorded in August and September, > 3,000. Annual numbers varied greatly and peak numbers were observed in 2015 and 2019, 1,832 and 2,250, respectively, whereas some other years the numbers were 700 - 800. There was also much variation in the annual and monthly percentages of positive samples and they varied between less than 10% to greater than 20%. The highest percentages of positive samples were recorded in September and October. IgG and IgM titers declined with age and these differences were highly significant for IgG titers, with decreasing average titers for each 20-year interval. Discussion Collectively, the data demonstrate the marked annual and seasonal variations in tularemia sampling occurring in Sweden. Also, the proportion of positive samples increased during months and years with peak number of samples. Another notable finding was that average antibody titers decreased with increased age.
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Affiliation(s)
- Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Xijia Liu
- Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Lindgren H, Eklund J, Eneslätt K, Sjöstedt A. Kinetics of the serological response up to one year after tularemia. Front Cell Infect Microbiol 2023; 12:1072703. [PMID: 36683705 PMCID: PMC9853284 DOI: 10.3389/fcimb.2022.1072703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/07/2022] [Indexed: 01/08/2023] Open
Abstract
Serological analysis is the predominant method used to diagnose tularemia, a zoonotic disease caused by the highly virulent bacterium F. tularensis. We determined F. tularensis-specific IgM and IgG antibody titers by an LPS-based ELISA assay on five occasions one to twelve months after onset of ulceroglandular tularemia in 19 individuals. Peak IgM antibody titers were observed at the one-month time point and peak IgG antibody titers at the two-month time point. Both IgG and IgM antibody levels declined linearly thereafter with rather similar kinetics. Compared to the average one-month antibody titers, average IgG titers were not significantly lower before the 12-month time point and IgM titers before the 4-month time point. All, but one average titer, were significantly increased compared to the cut-off of the assay. Average IgG and IgM titers were significantly lower for the group = 69 years old compared to the group < 69 years. Collectively, the data demonstrate a persistence of F. tularensis-specific IgM and IgG antibody titers for at least 12 months after ulceroglandular tularemia. Thus, low, but significantly elevated F. tularensis-specific antibody titers are of limited diagnostic value since they are not indicative of ongoing tularemia.
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Affiliation(s)
- Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Johan Eklund
- Ljusdal-Ramsjö Primary Care Centre, Ljusdal, Sweden
| | - Kjell Eneslätt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden,*Correspondence: Anders Sjöstedt,
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Xu JH, Kang L, Yuan B, Feng ZH, Li SQ, Wang J, Wang YR, Xin WW, Gao S, Li JX, Sun YS, Wang JL, Yuan Y. Development and evaluation of a rapid RPA/CRISPR-based detection of Francisella tularensis. Front Microbiol 2022; 13:901520. [PMID: 36033876 PMCID: PMC9399789 DOI: 10.3389/fmicb.2022.901520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Francisella tularensis is a dangerous pathogen that causes an extremely contagious zoonosis in humans named tularemia. Given its low-dose morbidity, the potential to be fatal, and aerosol spread, it is regarded as a severe threat to public health. The US Centers for Disease Control and Prevention (CDC) has classified it as a category A potential agent for bioterrorism and a Tier 1 Select Agent. Herein, we combined recombinase polymerase amplification (RPA) with CRISPR/Cas12a system to select the F. tularensis target gene (TUL4), creating a two-pronged rapid and ultrasensitive diagnostic method for detecting F. tularensis. The real-time RPA (RT-RPA) assay detected F. tularensis within 10 min at a sensitivity of 5 copies/reaction, F. tularensis genomic DNA of 5 fg, and F. tularensis of 2 × 102 CFU/ml; the RPA-CRISPR/Cas12a assay detects F. tularensis within 40 min at a sensitivity of 0.5 copies/reaction, F. tularensis genomic DNA of 1 fg, and F. tularensis of 2 CFU/ml. Furthermore, the evaluation of specificity showed that both assays were highly specific to F. tularensis. More importantly, in a test of prepared simulated blood and sewage samples, the RT-RPA assay results were consistent with RT-PCR assay results, and the RPA-CRISPR/Cas12a assay could detect a minute amount of F. tularensis genomic DNA (2.5 fg). There was no nonspecific detection with blood samples and sewage samples, giving the tests a high practical application value. For example, in on-site and epidemic areas, the RT-RPA was used for rapid screening and the RPA-CRISPR/Cas12a assay was used for more accurate diagnosis.
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Affiliation(s)
- Jian-Hao Xu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Lin Kang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Bing Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Zi-Han Feng
- Department of Disease Control and Prevention, The No. 96609 Hospital of Chinese People's Liberation Army, Yinchuan, China
| | - Shi-Qing Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Jing Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Ya-Ru Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Wen-Wen Xin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Shan Gao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Jia-Xin Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Yan-Song Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- *Correspondence: Yan-Song Sun
| | - Jing-Lin Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
- Jing-Lin Wang
| | - Yuan Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- Yuan Yuan
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Markowicz M, Schötta AM, Penatzer F, Matscheko C, Stanek G, Stockinger H, Riedler J. Isolation of Francisella tularensis from Skin Ulcer after a Tick Bite, Austria, 2020. Microorganisms 2021; 9:microorganisms9071407. [PMID: 34209915 PMCID: PMC8304467 DOI: 10.3390/microorganisms9071407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Ulceroglandular tularemia is caused by the transmission of Francisella tularensis by arthropods to a human host. We report a case of tick-borne tularemia in Austria which was followed by an abscess formation in a lymph node, making drainage necessary. F. tularensis subsp. holarctica was identified by PCR and multilocus sequence typing.
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Affiliation(s)
- Mateusz Markowicz
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
- Correspondence: ; Tel.: +043-1-40160-33023
| | - Anna-Margarita Schötta
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Freya Penatzer
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
| | - Christoph Matscheko
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
| | - Gerold Stanek
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Hannes Stockinger
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Josef Riedler
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
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Zeggay A, Anxionnat R, Chirouze C, Plésiat P, Jeannot K, Caspar Y, Potron A. An unusual digestive infection due to Francisella tularensis: A case report. Infect Dis Now 2021; 51:680-682. [PMID: 33870890 DOI: 10.1016/j.idnow.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A Zeggay
- Service de Pédiatrie, Centre Hospitalier Universitaire de Besançon, Besançon, France; Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - R Anxionnat
- Service de Pédiatrie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - C Chirouze
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Besançon, Besançon, France; UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France
| | - P Plésiat
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - K Jeannot
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Y Caspar
- Centre National de Référence des Francisella, Centre Hospitalier Universitaire de Grenoble, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France
| | - A Potron
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France.
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Evaluation of the Biotoxis qPCR Detection Kit for Francisella tularensis Detection in Clinical and Environmental Samples. J Clin Microbiol 2020; 59:JCM.01434-20. [PMID: 33115844 DOI: 10.1128/jcm.01434-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/16/2020] [Indexed: 11/20/2022] Open
Abstract
Rapid and reliable detection and identification of Francisella tularensis (a tier 1 select agent) are of primary interest for both medical and biological threat surveillance purposes. The Biotoxis qPCR detection kit is a real-time quantitative PCR (qPCR) assay designed for the detection of Bacillus anthracis, Yersinia pestis, and F. tularensis in environmental or biological samples. Here, we evaluated its performance for detecting F. tularensis in comparison to previously validated qPCR assays. The Biotoxis qPCR was positive for 87/87 F. tularensis subsp. holarctica (type B) strains but also for F. tularensis subsp. novicida It was negative for Francisella philomiragia and 24/24 strains belonging to other bacterial species. For 31 tularemia clinical specimens, the Biotoxis qPCR displayed a sensitivity between 90.32% and 96.55%, compared to qPCR tests targeting ISFtu2 or a type B-specific DNA sequence, respectively. All 30 nontularemia clinical specimens were Biotoxis qPCR negative. For water samples, the Biotoxis qPCR limit of detection was 1,000 CFU/liter of F. tularensis For 57 environmental water samples collected in France, the Biotoxis qPCR was positive for 6/15 samples positive for ISFtu2 qPCR and 4/4 positive for type B qPCR. In conclusion, the Biotoxis qPCR detection kit demonstrated good performances for F. tularensis detection in various biological and environmental samples, although cross-amplification of F. tularensis subsp. novicida must be considered. This plate format assay could be useful to test a large number of clinical or environmental specimens, especially in the context of natural or intentional tularemia outbreaks.
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Maurin M. Francisella tularensis, Tularemia and Serological Diagnosis. Front Cell Infect Microbiol 2020; 10:512090. [PMID: 33194778 PMCID: PMC7649319 DOI: 10.3389/fcimb.2020.512090] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Tularemia is a zoonotic disease caused by the bacterium Francisella tularensis. The predominant sources, routes of infection, and clinical manifestations of human infections greatly vary according to the geographic area considered. Moreover, clinical suspicion of tularemia is often tricky because of the lack of specificity of the clinical manifestations. Because F. tularensis isolation is tedious and detection of its DNA usually requires removal of infected tissues, serological techniques are most often used for diagnostic confirmation. However, these techniques are varied and poorly standardized. The microagglutination test (MAT), the indirect immunofluorescence assay (IFA), and ELISA tests are currently the most frequently used techniques. These home-made and commercial tests are mainly used for tularemia diagnosis but also seroprevalence studies. ELISA tests detect specific antibodies within two weeks of disease evaluation, compared to 2-3 weeks for MAT and IFA. However, more false-positive results are usually reported with ELISA. The long-term persistence of anti-F. tularensis antibodies in patients with past tularemia infection hampers the diagnostic specificity of all these tests. Also, cross-reacting antibodies have been described (especially with Brucella and Yersinia species), although usually at a low level. The immunoblotting technique can highlight these serological cross-reactions. Tularemia remains an underdiagnosed disease in most endemic areas, and the clinical presentations of this disease are evolving. It is necessary to improve further speed and accuracy of tularemia diagnosis, as well as the standardization of diagnostic procedures.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité Informatique-Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, Centre National de la Recherche Scientifique (CNRS), Grenoble, France
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Ly TDA, Louni M, Hoang VT, Dao TL, Badiaga S, Brouqui P, Tissot-Dupont H, Raoult D, Fournier PE, Gautret P. Epidemiological serosurvey of vector-borne and zoonotic pathogens among homeless people living in shelters in Marseille: cross-sectional one-day surveys (2005-2015). Eur J Clin Microbiol Infect Dis 2020; 39:1663-1672. [PMID: 32318966 DOI: 10.1007/s10096-020-03889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/30/2020] [Indexed: 10/23/2022]
Abstract
Homeless people are often exposed to unhygienic environments as well as to animals carrying arthropods which both transmit zoonotic infections and human louse-borne pathogens. We attempted to determine the prevalence of antibodies against several vector-borne and zoonotic pathogens among homeless adults living in Marseille. During the 2005-2015 period, we collected sera samples from 821 homeless adults living in shelters. Antibodies against Bartonella quintana, Bartonella henselae, Borrelia recurrentis, Coxiella burnetii, Francisella tularensis (with a cut-off of 1:100), Rickettsia akari, Rickettsia conorii, Rickettsia felis, Rickettsia prowazekii, and Rickettsia typhi (with a cut-off of 1:64) were searched by microimmunofluorescence (MIF). MIF-positive serum samples were confirmed by cross-adsorption to characterise cross-reacting antigens and immunoblotting. Positive sera by Western blot were further tested using qPCR. We evidenced a prevalence of 4.9% seroreactivity to at least one pathogen including phase II C. burnetii (2.1%), B. quintana (1.7%), R. conorii (0.4%), R. prowazekii (0.4%), R. typhi (0.1%), B. recurrentis (0.1%), and F. tularensis (0.1%). No DNA from any pathogens was detected. A comparison with studies conducted prior to the 2000-2003 period showed a decrease in the overall seroprevalence of several vector-borne and zoonotic infections.
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Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Meriem Louni
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Pneumology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Sekene Badiaga
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, Service des urgences CHU Hôpital Nord, Marseille, France
| | - Phillipe Brouqui
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Hervé Tissot-Dupont
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
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Hidalgo J, Woc-Colburn L. Zoonotic Infections and Biowarfare Agents in Critical Care: Anthrax, Plague, and Tularemia. HIGHLY INFECTIOUS DISEASES IN CRITICAL CARE 2020. [PMCID: PMC7122055 DOI: 10.1007/978-3-030-33803-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bacterial zoonotic infections are rare in developed countries in the twenty-first century but may cause major morbidity and mortality in developing regions of the world. In addition, their potential use as biological weapons makes early recognition and effective empiric therapy important for the critical care practitioner. Anthrax, plague, and tularemia share overlapping presenting syndromes, including fulminant respiratory infections and less severe but still highly morbid lymphocutaneous infections. Although all three may be transmitted as infectious aerosols, only plague has a risk of direct human-to-human transmission. Diagnostic testing will require special precautions for laboratory staff and most often involvement of regional and national reference laboratories. Empiric therapy with aminoglycosides may be life-saving for plague and tularemia, while the treatment of anthrax is complex and varies depending on the site of infection. In outbreaks or for post-exposure prophylaxis, treatment with doxycycline or a fluoroquinolone is recommended for all three diseases.
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Affiliation(s)
- Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
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Balestra A, Bytyci H, Guillod C, Braghetti A, Elzi L. A case of ulceroglandular tularemia presenting with lymphadenopathy and an ulcer on a linear morphoea lesion surrounded by erysipelas. Int Med Case Rep J 2018; 11:313-318. [PMID: 30519119 PMCID: PMC6237246 DOI: 10.2147/imcrj.s178561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tularemia is a zoonosis caused by the infection of Francisella tularensis (a gram-negative aerobic bacterium). Transmission to other animals or humans usually occurs through insect or tick bites, direct contact with a contaminated environment (mud or water), infected animals - mainly lagomorphs - or by ingesting undercooked meat or inhaling contaminated dust (hay or soil). This paper discusses the case of a 32-year-old man, who came to our Emergency Room presenting with persistent fever, inguinal lymphadenopathy, and an ulcer on his left lower limb on a linear morphoea lesion that had been there for some time. The lesion was surrounded by erysipelas. After hospitalization and tests, the patient was diagnosed with ulceroglandular tularemia. Antibiotic treatment with doxycycline resolved the clinical picture, but not the morphoea lesion.
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Affiliation(s)
- Alessandra Balestra
- Department of Internal Medicine, Regional Hospital of Bellinzona e Valli, 6500 Bellinzona, Ticino, Switzerland,
| | - Hekuran Bytyci
- Department of Internal Medicine, Regional Hospital of Bellinzona e Valli, 6500 Bellinzona, Ticino, Switzerland,
| | - Caroline Guillod
- Department of Dermatology, Regional Hospital of Bellinzona e Valli, 6500 Bellinzona, Ticino, Switzerland
| | - Antonio Braghetti
- Department of Radiology, Regional Hospital of Bellinzona e Valli, 6500 Bellinzona, Ticino, Switzerland
| | - Luigia Elzi
- Department of Infectious Diseases, Regional Hospital of Bellinzona e Valli, 6500 Bellinzona, Ticino, Switzerland
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