Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003-20151

Computational and Systems Biology Advances to Enable Bioagent Agnostic Signatures

Enumerated threat agent lists have long driven biodefense priorities. The global SARS-CoV-2 pandemic demonstrated the limitations of searching for known threat agents as compared to a more agnostic approach. Recent technological advances are enabling agent-agnostic biodefense, especially through the integration of multi-modal observations of host-pathogen interactions directed by a human immunological model. Although well-developed technical assays exist for many aspects of human-pathogen interaction, the analytic methods and pipelines to combine and holistically interpret the results of such assays are immature and require further investments to exploit new technologies. In this manuscript, we discuss potential immunologically based bioagent-agnostic approaches and the computational tool gaps the community should prioritize filling.

Pulmonary tularaemia in a female adolescent with inflammatory bowel disease receiving infliximab: Do not miss the diagnosis

We report the first described case of pulmonary tularaemia in the pediatric patient receiving infliximab for ulcerative colitis. We highlight the importance of considering Francisella tularensis in diagnostically challenging cases of persistent respiratory symptoms to facilitate early diagnosis and adequate therapy. The TCR-γδ ⁺ DN T cells are gaining important role in clinical practice. Polymerase chain reaction assays and serology guarantee early recognition.

Tularemia Presenting Solely with Cervical Lymphadenopathy and Fever

A 52-year-old German female presented with cervical lymphadenopathy and fever. Despite the initial symptom-presentation leading to the consideration of sarcoidosis, lymphoma, tuberculosis, and toxoplasmosis, an extensive serologic and histo- and molecular pathologic workup eventually indicated a likely diagnosis of tularemia. This case brings to light that tularemia is a diagnostic challenge and requires high reliance on the epidemiological context thorough patient history, and an extensive interdisciplinary diagnostic workup.

[Mediastinal lymphadenopathy: Do not forget tularemia!]

INTRODUCTION

Mediastinal lymphadenopathy is a common cause of referral to the pulmonologist. In addition to more frequent aetiologies such as malignancy, sarcoidosis, tuberculosis and lymphoma, unusual causes must be considered, especially in specific contexts.

CASE SERIES

We report the cases of three young patients referred to our pulmonology department for the assessment of hypermetabolic mediastinal lymphadenopathy. The context of the onset of symptoms (tick bite, contact with an infected animal) as well as paraclinical investigations (Francisella tularensis serology) made it possible to make a diagnosis of tularemia. The clinical and radiological evolution was favourable in all three cases. Tularemia is a rare but currently re-emerging infection caused by a Gram negative coccobacillus, Francisella tularensis. Human contamination occurs mainly through contact with infected animals or by tick bites. The diagnosis can be difficult because the symptoms (fever, diffuse myalgia) are non-specific, and is based on serology and an appropriate clinical context. Treatment is based on ciprofloxacin or doxycycline.

CONCLUSION

The diagnosis of tularemia must be considered in the presence of lymphadenopathy occurring after a tick bite or contact with an infected animal.