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Beeson AM, Baker M, Dell B, Schnitzler H, Oltean HN, Woodall T, Riedo F, Schwartz A, Petersen J, Hinckley AF, Marx GE. Francisella tularensis Bone and Joint Infections: United States, 2004-2023. Clin Infect Dis 2024; 78:S67-S70. [PMID: 38294110 DOI: 10.1093/cid/ciad688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Tularemia is caused by the highly infectious bacterium Francisella tularensis, which is recognized as a Tier 1 bioterrorism agent. Tularemia has a range of recognized clinical manifestations, but fewer than 20 bone or joint infections from 6 countries have been reported in the literature to date. This series includes 13 cases of F. tularensis septic arthritis or osteomyelitis in the United States during 2004-2023 and describes exposures, clinical presentation, diagnosis, and outcomes for this rare but severe form of tularemia. Clinicians should consider F. tularensis in patients with compatible exposures or a history of joint replacement or immunosuppression.
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Affiliation(s)
- Amy M Beeson
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Molly Baker
- Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA
| | - BreeAnna Dell
- Public Health-Seattle and King County, Seattle, Washington, USA
| | | | - Hanna N Oltean
- Washington State Department of Health, Shoreline, Washington, USA
| | - Tracy Woodall
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | - Amy Schwartz
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Jeannine Petersen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Grace E Marx
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
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Cash-Goldwasser S, Beeson A, Marzec N, Ho DY, Hogan CA, Budvytiene I, Banaei N, Born DE, Gephart MH, Patel J, Dietrich EA, Nelson CA. Neuroinvasive Francisella tularensis Infection: Report of 2 Cases and Review of the Literature. Clin Infect Dis 2024; 78:S55-S63. [PMID: 38294117 DOI: 10.1093/cid/ciad719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Neuroinvasive infection with Francisella tularensis, the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. METHODS We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. RESULTS One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. CONCLUSIONS Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment.
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Affiliation(s)
- Shama Cash-Goldwasser
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Amy Beeson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Natalie Marzec
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Catherine A Hogan
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Niaz Banaei
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Donald E Born
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Melanie H Gephart
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Elizabeth A Dietrich
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Christina A Nelson
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Maurin M, Pondérand L, Hennebique A, Pelloux I, Boisset S, Caspar Y. Tularemia treatment: experimental and clinical data. Front Microbiol 2024; 14:1348323. [PMID: 38298538 PMCID: PMC10827922 DOI: 10.3389/fmicb.2023.1348323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Tularemia is a zoonosis caused by the Gram negative, facultative intracellular bacterium Francisella tularensis. This disease has multiple clinical presentations according to the route of infection, the virulence of the infecting bacterial strain, and the underlying medical condition of infected persons. Systemic infections (e.g., pneumonic and typhoidal form) and complications are rare but may be life threatening. Most people suffer from local infection (e.g., skin ulcer, conjunctivitis, or pharyngitis) with regional lymphadenopathy, which evolve to suppuration in about 30% of patients and a chronic course of infection. Current treatment recommendations have been established to manage acute infections in the context of a biological threat and do not consider the great variability of clinical situations. This review summarizes literature data on antibiotic efficacy against F. tularensis in vitro, in animal models, and in humans. Empirical treatment with beta-lactams, most macrolides, or anti-tuberculosis agents is usually ineffective. The aminoglycosides gentamicin and streptomycin remain the gold standard for severe infections, and the fluoroquinolones and doxycycline for infections of mild severity, although current data indicate the former are usually more effective. However, the antibiotic treatments reported in the literature are highly variable in their composition and duration depending on the clinical manifestations, the age and health status of the patient, the presence of complications, and the evolution of the disease. Many patients received several antibiotics in combination or successively. Whatever the antibiotic treatment administered, variable but high rates of treatment failures and relapses are still observed, especially in patients treated more then 2-3 weeks after disease onset. In these patients, surgical treatment is often necessary for cure, including drainage or removal of suppurative lymph nodes or other infectious foci. It is currently difficult to establish therapeutic recommendations, particularly due to lack of comparative randomized studies. However, we have attempted to summarize current knowledge through proposals for improving tularemia treatment which will have to be discussed by a group of experts. A major factor in improving the prognosis of patients with tularemia is the early administration of appropriate treatment, which requires better medical knowledge and diagnostic strategy of this disease.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Léa Pondérand
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Aurélie Hennebique
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Isabelle Pelloux
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
| | - Sandrine Boisset
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Yvan Caspar
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
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Mohammed RR, Enferadi A, Sidiq KR, Sarani S, Khademi P, Jaydari A, Ahmed AK. Molecular Detection of Francisella tularensis Isolated from Ticks of Livestock in Kurdistan Region, Iraq. Vector Borne Zoonotic Dis 2023; 23:514-519. [PMID: 37582218 DOI: 10.1089/vbz.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Francisella tularensis is a Gram-negative bacterium that causes tularemia in both human and animals. Tularemia is a potential serious zoonotic disease that is transmitted by different routes, including tick bites. Materials and Methods: This study deals with investigating the prevalence of F. tularensis in the ticks of local animal farms in Kurdistan region since the farmers are normally in close contact with livestock. We used molecular methods for this purpose. A total of 412 tick and 126 blood samples were gathered from goat, sheep, and cow flocks. The existence of F. tularensis 16Sr RNA gene was examined in the samples using nested-PCR technique. Results: In the animal blood specimens, no F. tularensis was found. The incidence of F. tularensis was 1.7% (7 out of 412) in the tick samples, representing a very lower possibility of tuleremia infection. Moreover, the two subspecies of F. tularensis novicida and holarctica were identified based on the sequencing of pdpD and RD genes, respectively. The F. tularensis subsp. novicida was isolated from four species of ticks, Hyalomma anatolicum, Rhipicephalus annulatus, Rhipicephalus sanguineus, and Ornithodoros spp., whereas the F. tularensis subsp. holarctica was isolated from Haemaphysalis parva and Hyalomma dromedarii species of ticks. Conclusion: Although its prevalence is very low, the isolation of F. tularensis subsp. holarctica from the ticks of farm animals suggests possible transmission of Tularemia through tick bite in Kurdistan region of Iraq. Ref: IR-UU-AEC-3/22.
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Affiliation(s)
- Rebin Rafaat Mohammed
- Department of Pathobiology, Faculty of Veterinary Medicine, Urmia University, West Azerbaijan, Iran
| | - Ahmad Enferadi
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, West Azerbaijan, Iran
| | - Karzan R Sidiq
- Charmo Centre for Research, Training and Consultancy, Charmo University, Chamchamal, Iraq
| | - Saeedeh Sarani
- Department of Pathobiology, Faculty of Veterinary Medicine, Zabol University, Sistan and Balochistan, Iran
| | - Peyman Khademi
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran
| | - Amin Jaydari
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran
| | - Avin Kawa Ahmed
- Sulaimani Veterinary Directorate, Chamchamal Veterinary Hospital, Sulaimani, Iraq
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Assessment of Zoonotic Risk following Diagnosis of Canine Tularemia in a Veterinary Medical Teaching Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042011. [PMID: 35206199 PMCID: PMC8872237 DOI: 10.3390/ijerph19042011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
Tularemia is a rare zoonotic disease found worldwide. The agent responsible for disease, Francisella tularensis, is one of the most highly infectious pathogens known, one that is capable of causing life-threatening illness with inhalation of <50 organisms. High infectivity explains concerns of its use in bioterrorism. This case describes a 4-year-old male neutered Australian shepherd presented for evaluation of hyporexia and fever. Physical examination revealed marked enlargement of the right superficial cervical lymph node. Tularemia lymphadenitis was diagnosed by lymph node aspiration cytology and culture. Public health officials were advised of the isolation of this zoonotic pathogen, and contact tracing was instituted. Seven individuals associated with the aspiration event were screened for tularemia and treated with prophylactic ciprofloxacin. All were negative, and none became sick. The dog was treated with doxycycline for 3 weeks, and clinical signs and physical examination abnormalities were resolved fully. The owner, a solid organ transplant recipient, was also screened for disease and received prophylactic doxycycline due to a history of shared exposure. The owner remained well throughout the course of his dog’s disease and has heightened awareness of potential zoonoses. This case highlights the importance of animals as a sentinel for human health threats and for coordination of human and veterinary care.
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Host Immunity and Francisella tularensis: A Review of Tularemia in Immunocompromised Patients. Microorganisms 2021; 9:microorganisms9122539. [PMID: 34946140 PMCID: PMC8707036 DOI: 10.3390/microorganisms9122539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/31/2023] Open
Abstract
Tularemia, caused by the bacterium Francisella tularensis, is an infrequent zoonotic infection, well known in immunocompetent (but poorly described in immunocompromised) patients. Although there is no clear literature data about the specific characteristics of this disease in immunocompromised patients, clinical reports seem to describe a different presentation of tularemia in these patients. Moreover, atypical clinical presentations added to the fastidiousness of pathogen identification seem to be responsible for a delayed diagnosis, leading to a” loss of chance” for immunocompromised patients. In this article, we first provide an overview of the host immune responses to Francisella infections and discuss how immunosuppressive therapies or diseases can lead to a higher susceptibility to tularemia. Then, we describe the particular clinical patterns of tularemia in immunocompromised patients from the literature. We also provide hints of an alternative diagnostic strategy regarding these patients. In conclusion, tularemia should be considered in immunocompromised patients presenting pulmonary symptoms or unexplained fever. Molecular techniques on pathological tissues might improve diagnosis with faster results.
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Hannah EE, Pandit SG, Hau D, DeMers HL, Robichaux K, Nualnoi T, Dissanayaka A, Arias-Umana J, Green HR, Thorkildson P, Pflughoeft KJ, Gates-Hollingsworth MA, Ozsurekci Y, AuCoin DP. Development of Immunoassays for Detection of Francisella tularensis Lipopolysaccharide in Tularemia Patient Samples. Pathogens 2021; 10:pathogens10080924. [PMID: 34451388 PMCID: PMC8401977 DOI: 10.3390/pathogens10080924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Francisella tularensis is the causative agent of tularemia, a zoonotic bacterial infection that is often fatal if not diagnosed and treated promptly. Natural infection in humans is relatively rare, yet persistence in animal reservoirs, arthropod vectors, and water sources combined with a low level of clinical recognition make tularemia a serious potential threat to public health in endemic areas. F. tularensis has also garnered attention as a potential bioterror threat, as widespread dissemination could have devastating consequences on a population. A low infectious dose combined with a wide range of symptoms and a short incubation period makes timely diagnosis of tularemia difficult. Current diagnostic techniques include bacterial culture of patient samples, PCR and serological assays; however, these techniques are time consuming and require technical expertise that may not be available at the point of care. In the event of an outbreak or exposure a more efficient diagnostic platform is needed. The lipopolysaccharide (LPS) component of the bacterial outer leaflet has been identified previously by our group as a potential diagnostic target. For this study, a library of ten monoclonal antibodies specific to F. tularensis LPS were produced and confirmed to be reactive with LPS from type A and type B strains. Antibody pairs were tested in an antigen-capture enzyme-linked immunosorbent assay (ELISA) and lateral flow immunoassay format to select the most sensitive pairings. The antigen-capture ELISA was then used to detect and quantify LPS in serum samples from tularemia patients for the first time to determine the viability of this molecule as a diagnostic target. In parallel, prototype lateral flow immunoassays were developed, and reactivity was assessed, demonstrating the potential utility of this assay as a rapid point-of-care test for diagnosis of tularemia.
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Affiliation(s)
- Emily E. Hannah
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Sujata G. Pandit
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Derrick Hau
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Haley L. DeMers
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Kayleigh Robichaux
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Teerapat Nualnoi
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Anjana Dissanayaka
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Jose Arias-Umana
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Heather R. Green
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Peter Thorkildson
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Kathryn J. Pflughoeft
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | - Marcellene A. Gates-Hollingsworth
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
| | | | - David P. AuCoin
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV 89509, USA; (E.E.H.); (S.G.P.); (D.H.); (H.L.D.); (K.R.); (T.N.); (A.D.); (J.A.-U.); (H.R.G.); (P.T.); (K.J.P.); (M.A.G.-H.)
- Correspondence:
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Ducatez N, Melboucy S, Bentayeb H, Dayen C, Suguenot R, Lecuyer E, Douadi Y. A case of Francisella tularensis meningitis in a 64-year-old man treated with quinolones. Infect Dis Now 2021; 52:107-109. [PMID: 34242839 DOI: 10.1016/j.idnow.2021.06.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
We report a French case of tularemic meningitis - the second to be thoroughly described - and discuss the existing literature. The patient is a 64-year-old man with no medical history, who developed fever, cutaneous symptoms, and swollen lymph nodes within a week after a hunt. He was then diagnosed with meningitis caused by Francisella tularensis subsp. holarctica. Healing was quickly achieved ad integrum within 3 weeks with a course of ciprofloxacin. We discuss the existing literature about this specific issue, and try to shine a light on the superior efficacy and lesser toxicity of quinolones compared to the historical treatment.
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Affiliation(s)
- N Ducatez
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France.
| | - S Melboucy
- Service de médecine interne et polyvalente, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - H Bentayeb
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France
| | - C Dayen
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France
| | - R Suguenot
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France
| | - E Lecuyer
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France
| | - Y Douadi
- Service de pneumologie et pathologies infectieuses, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100 Saint-Quentin, France
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